PRAMS Opioid Call-back Surveys

Pregnancy Risk Assessment Monitoring System (PRAMS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1273 can be found here:

Documents and Forms

Document Name Document Type
PRAMS Opioid Call-back Surveys Form and Instruction
PRAMS Opioid Call-back Survey (English) Att 11a-PRAMS Opioid Call Back Survey_DRAFT_PHONE_ENGLISH_040819.docx Form and Instruction
PRAMS Opioid Call-back Survey (Spanish) Att 11b-PRAMS Opioid Call Back Survey_DRAFT_PHONE_SPANISH_040819.docx Form and Instruction
Att 13a-Call Back Survey Opt Out Recontact Mail_English.docx Call-back Survey Opt-out Recontact for Mail Survey (English) IC Document
Att 13b-Call Back Survey Opt Out Recontact Mail_Spanish.docx Call-back Survey Opt-out Recontact for Mail Survey (Spanish) IC Document
Att 13c-Call Back Survey Opt Out Recontact Phone_English.docx Call-back Survey Opt-out Recontact for Phone Survey (English) IC Document
Att 13d-Call Back Survey Opt Out Recontact Phone_Spanish.docx Call-back Survey Opt-out Recontact for Phone Survey (Spanish) IC Document

Information Collection (IC) Details

IC Title:	PRAMS Opioid Call-back Surveys	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	PRAMS Opioid Call-back Survey (English)	Att 11a-PRAMS Opioid Call Back Survey_DRAFT_PHONE_ENGLISH_040819.docx		No		Paper Only
Form and Instruction	n/a	PRAMS Opioid Call-back Survey (Spanish)	Att 11b-PRAMS Opioid Call Back Survey_DRAFT_PHONE_SPANISH_040819.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160	FR Citation: 51 FR 42484

Number of Respondents: 3,961	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	3,961	3,961
Annual IC Time Burden (Hours)	1,981	1,981
Annual IC Cost Burden (Dollars)	48,601	48,601

Documents for IC

Title	Document	Date Uploaded
Call-back Survey Opt-out Recontact for Mail Survey (English)	Att 13a-Call Back Survey Opt Out Recontact Mail_English.docx	06/20/2019
Call-back Survey Opt-out Recontact for Mail Survey (Spanish)	Att 13b-Call Back Survey Opt Out Recontact Mail_Spanish.docx	06/20/2019
Call-back Survey Opt-out Recontact for Phone Survey (English)	Att 13c-Call Back Survey Opt Out Recontact Phone_English.docx	06/20/2019
Call-back Survey Opt-out Recontact for Phone Survey (Spanish)	Att 13d-Call Back Survey Opt Out Recontact Phone_Spanish.docx	06/20/2019

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