Information Collection

PRAMS Opioid 2018 - English

IC 233751 under ICR 201807-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

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 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 %

table that charts list of burden
	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

table that charts IC Documents
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.