PRAMS Stillbirth Survey

Pregnancy Risk Assessment Monitoring System (PRAMS)

OMB: 0920-1273

IC ID: 236591

Information Collection (IC) Details

View Information Collection (IC)

PRAMS Stillbirth Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a PRAMS Stillbirth Mail Questionnaire (English) Att 8a-PRAMS UT Stillbirth Questionnaire Mail_English.pdf No   Paper Only
Form and Instruction n/a PRAMS Stillbirth Mail Questionnaire (Spanish) Att 8b-PRAMS UT Stillbirth Questionnaire Mail_Spanish.pdf No   Paper Only
Form and Instruction n/a PRAMS Stillbirth Phone Questionnaire (English) Att 8c-PRAMS UT Stillbirth Phone Questionnaire_English.docx No   Paper Only
Form and Instruction n/a PRAMS Stillbirth Phone Questionnaire (Spanish) Att 8d-PRAMS UT Stillbirth Phone Questionnaire_Spanish.docx No   Paper Only

Health Public Health Monitoring

09-20-0160 Records of Subjects in Health Promotion and Education Studies  51 FR 42484

160 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 160 0 0 0 160 0
Annual IC Time Burden (Hours) 67 0 0 0 67 0
Annual IC Cost Burden (Dollars) 1,636 0 0 0 1,636 0

Title Document Date Uploaded
Introduction and Informed Consent for the Stillbirth Mail Survey (English) Att 12c-PRAMS Stillbirth Introduction and Informed Consent Mail_English.docx 06/20/2019
Introduction and Informed Consent for the Stillbirth Mail Survey (Spanish) Att 12d-PRAMS Stillbirth Introduction and Informed Consent Mail_Spanish.docx 06/20/2019
Introduction and Informed Consent for the Stillbirth Phone Survey (English) Att 12g-PRAMS Stillbirth Introduction and Informed Consent_Phone_English.docx 06/20/2019
Introduction and Informed Consent for the Stillbirth Phone Survey (Spanish) Att 12h-PRAMS Stillbirth Introduction and Informed Consent_Phone_Spanish.docx 06/20/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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