PRAMS Opioid 2018 - English

Collaborating Center for Questionnaire Design and Evaluation Research

⚠️ Notice: This information collection may be referencing outdated material.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
PRAMS Opioid 2018 - English Form
PRAMS Opioid 2018 Attach 1 Questionnaire 091918.docx Form
Telephone Screener Attach 3 - Telephone Screener 091918.docx Form
Respondent Data Sheet Attach 5 - Resp Data Collect Sheet 091918.doc Form
PRAMS Opioid English 2018 10-day 101718.docx Letter to Dr. Schwab IC Document
Attach 2a-c - Ad-flyer.doc Recruitment Flyers IC Document
Attach 4 - Informed Consent 091918.docx Consent IC Document
Attach 6 - Thank you letter.doc Thank you letter IC Document

Information Collection (IC) Details

IC Title:	PRAMS Opioid 2018 - English	Agency IC Tracking Number:	0920-0222-19BU

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 Opioid 2018	Attach 1 Questionnaire 091918.docx	Yes	No	Fillable Printable
Form	none	Telephone Screener	Attach 3 - Telephone Screener 091918.docx	Yes	No	Fillable Printable
Form	none	Respondent Data Sheet	Attach 5 - Resp Data Collect Sheet 091918.doc	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health and Demographic Surveys Conducted in Probability Samples of the US Population	FR Citation: 49 FR 37693

Number of Respondents: 176	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	176	176
Annual IC Time Burden (Hours)	68	68
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter to Dr. Schwab	PRAMS Opioid English 2018 10-day 101718.docx	10/29/2018
Recruitment Flyers	Attach 2a-c - Ad-flyer.doc	10/29/2018
Consent	Attach 4 - Informed Consent 091918.docx	10/29/2018
Thank you letter	Attach 6 - Thank you letter.doc	10/29/2018

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