Information Collection

Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)

IC 236479 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⚠️ Notice: This information collection may be referencing outdated material.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
Telephone Screening Script (in Spansih) Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)	Form and Instruction
PRAMS 2019 questions to be cognitively tested (Phone/Spanish version) Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)	Form and Instruction
Respondent Data Sheet (in Spanish) Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)	Form and Instruction
Telephone Screening Script (in Spansih) 0920 0222 Attach 3 Screener Span PRAMS 2019.docx	Form and Instruction
PRAMS 2019 questions to be cognitively tested (Phone/Spa 0920 0222 Attach 1 Qnne Span PRAMS 2019.docx	Form and Instruction
Respondent Data Sheet (in Spanish) 0920 0222 Attach 5 Resp Data Collect Span PRAMS 2019.docx	Form and Instruction
0920-0222 Span PRAMS 2019 10-Day Ltr 6.13.19.docx Project Description and Justification	IC Document
0920 0222 Attach 2abc Ad&flyer Span PRAMS 2019.docx Recruitment Advertisements (in Spanish)	IC Document
0920 0222 Attach 4 Consent Span PRAMS 2019.docx Consent Form (in Spanish)	IC Document
0920 0222 Attach 6 Thank You Span PRAMS 2019.docx Thank You Letter (in Spanish)	IC Document

IC Title:

Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)

Agency IC Tracking Number:

0920-19BGZ

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?	Electronic Capability
Form and Instruction	n/a	Telephone Screening Script (in Spansih)	0920 0222 Attach 3 Screener Span PRAMS 2019.docx	No	Paper Only
Form and Instruction	n/a	PRAMS 2019 questions to be cognitively tested (Phone/Spanish version)	0920 0222 Attach 1 Qnne Span PRAMS 2019.docx	No	Paper Only
Form and Instruction	n/a	Respondent Data Sheet (in Spanish)	0920 0222 Attach 5 Resp Data Collect Span PRAMS 2019.docx	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

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
Project Description and Justification	0920-0222 Span PRAMS 2019 10-Day Ltr 6.13.19.docx	06/13/2019
Recruitment Advertisements (in Spanish)	0920 0222 Attach 2abc Ad&flyer Span PRAMS 2019.docx	06/13/2019
Consent Form (in Spanish)	0920 0222 Attach 4 Consent Span PRAMS 2019.docx	06/13/2019
Thank You Letter (in Spanish)	0920 0222 Attach 6 Thank You Span PRAMS 2019.docx	06/13/2019

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