Information Collection

Pregnancy Risk Assessment Monitoring System

IC 211406 under ICR 201205-0920-001 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pregnancy Risk Assessment Monitoring System	Form
PRAMS Phase 8 0920-0222 Attach 1ab- PRAMS Qnne.docx	Form
Screener 0920-0222 Attach 3ab- PRAMS Screening script.docx	Form and Instruction
Consent 0920-0222 Attach 4ab- PRAMS Informed Consent.docx	Form
Respondent Data 0920-0222 Attach 5ab- PRAMS RespDataCollect.docx	Form
0920-0222 Attach 2ab- PRAMS Adv Flyer.docx Advertisement Flyer	IC Document
0920-0222 Attach 6ab- PRAMS thank you letter.docx Thank you letter	IC Document
0920-0222 Attach 7ab- PRAMS Spec Consent.docx Special Consent	IC Document
0920-0222 QDRL PRAMS EngSpan 10dayLetter3 042814.docx Letter to Dr. Schwab	IC Document

IC Title:

Pregnancy Risk Assessment Monitoring System

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	PRAMS Phase 8	0920-0222 Attach 1ab- PRAMS Qnne.docx	Yes	Yes	Fillable Fileable
Form and Instruction	none	Screener	0920-0222 Attach 3ab- PRAMS Screening script.docx	Yes	Yes	Fillable Fileable
Form	none	Consent	0920-0222 Attach 4ab- PRAMS Informed Consent.docx	Yes	Yes	Fillable Fileable
Form	none	Respondent Data	0920-0222 Attach 5ab- PRAMS RespDataCollect.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population

FR Citation: 49 FR 37693

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Advertisement Flyer	0920-0222 Attach 2ab- PRAMS Adv Flyer.docx	04/28/2014
Thank you letter	0920-0222 Attach 6ab- PRAMS thank you letter.docx	04/28/2014
Special Consent	0920-0222 Attach 7ab- PRAMS Spec Consent.docx	04/28/2014
Letter to Dr. Schwab	0920-0222 QDRL PRAMS EngSpan 10dayLetter3 042814.docx	04/28/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.