Pregnancy Risk Assessment Monitoring System

NCHS Questionnaire Design Research Laboratory

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Pregnancy Risk Assessment Monitoring System	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.