Information Collection

Cognitive Test for the Pregnancy Risk Assessment Monitoring System (PRAMS)

IC 236175 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0222 Cognitive Test for the Pregnancy Risk Assessment Monitoring System (PRAMS)	Form and Instruction
0920-0222 2019 Questions for Cognitive Testing 0920 0222 PRAMS Attach 1 Questions final.docx	Form and Instruction
0920-0222 Screener 0920 0222 PRAMS Attach 3 Screener.docx	Form and Instruction
0920-0222 Respondent Data 0920 0222 PRAMS Attach 5 Respondent Data.docx	Form and Instruction
0920 0222 PRAMS Attach 2abc Ads.docx Ads	IC Document
0920 0222 PRAMS Attach 4 Informed Consent.docx Informed Consent	IC Document
0920 0222 PRAMS Attach 6 Thank You Letter.docx Thank You Letter	IC Document
0920-0222 PRAMS 2019 10-Day Letter final.docx 10 Day Letter	IC Document

IC Title:

Cognitive Test for the Pregnancy Risk Assessment Monitoring System (PRAMS)

Agency IC Tracking Number:

0920-0222-19BCQ

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 and Instruction	0920-0222	2019 Questions for Cognitive Testing	0920 0222 PRAMS Attach 1 Questions final.docx	Yes	No	Fillable Fileable
Form and Instruction	0920-0222	Screener	0920 0222 PRAMS Attach 3 Screener.docx	Yes	No	Fillable Fileable
Form and Instruction	0920-0222	Respondent Data	0920 0222 PRAMS Attach 5 Respondent Data.docx	Yes	No	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 09-20-0164

FR Citation: 49 FR 37693

Number of Respondents: 80

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	80	80
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Ads	0920 0222 PRAMS Attach 2abc Ads.docx	05/23/2019
Informed Consent	0920 0222 PRAMS Attach 4 Informed Consent.docx	05/23/2019
Thank You Letter	0920 0222 PRAMS Attach 6 Thank You Letter.docx	05/23/2019
10 Day Letter	0920-0222 PRAMS 2019 10-Day Letter final.docx	05/23/2019

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