Information Collection

PRAMS Opioid 2018 -Spanish

IC 233753 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⚠️ Notice: This information collection may be referencing outdated material.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 -Spanish	Form
PRAMS Opioid 2018 - Spanish Attach 1 Questionnaire 102318.docx	Form
Telephone Screener - Spanish Attach 3 - Telephone Screener 102318.docx	Form
Respondent Data Collection Sheet Attach 5 - Respondent Data Sheet 102318.docx	Form
PRAMS Opioid 2018 10-day Spanish 102318.docx Letter to Dr. Schwab	IC Document
Attach 2a-c Adv Flyers 102318.docx Recruitment Flyers	IC Document
Attach 4 - Informed Consent 102318.docx Consent	IC Document
Attach 6 - Thank you letter 102318.docx Thank you letter	IC Document

IC Title:

PRAMS Opioid 2018 -Spanish

Agency IC Tracking Number:

0920-0222-19BY

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 - Spanish	Attach 1 Questionnaire 102318.docx	Yes	No	Fillable Printable
Form	none	Telephone Screener - Spanish	Attach 3 - Telephone Screener 102318.docx	Yes	No	Fillable Printable
Form	none	Respondent Data Collection Sheet	Attach 5 - Respondent Data Sheet 102318.docx	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 in the US Population

FR Citation: 49 FR 37693

Number of Respondents: 98

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	98	98
Annual IC Time Burden (Hours)	34	34
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 2018 10-day Spanish 102318.docx	10/29/2018
Recruitment Flyers	Attach 2a-c Adv Flyers 102318.docx	10/29/2018
Consent	Attach 4 - Informed Consent 102318.docx	10/29/2018
Thank you letter	Attach 6 - Thank you letter 102318.docx	10/29/2018

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