Information Collection Request

Pregnancy Risk Assessment Monitoring System (PRAMS)

ICR 202109-0920-010 · OMB 0920-1273 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
PRAMS Stillbirth Survey Form and Instruction Unchanged Repair queued
PRAMS Field Test Form and Instruction Unchanged Available
PRAMS Opioid Call-back Surveys Form and Instruction Unchanged Repair queued
PRAMS Supplemental Modules Form and Instruction Unchanged Missing upstream
PRAMS Phase 8 Questionnaire (Core Questions plus State-selected Standard Modules) Form and Instruction Modified Repair queued
PRAMS SS-B_10_21_19_clean.docx Supporting Statement B Uploaded 2021-09-29 Repair queued
PRAMS SS-A_11_4_19v2_clean.docx Supporting Statement A Uploaded 2021-09-29 Repair queued
Web module Change Request 0920-1273.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-09-23 Repair queued
0920-1273 Change Request Justification_6_07_21.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-06-22 Repair queued
Att 17-Field Testing Methodology.docx Supplementary Document Uploaded 2019-06-20 Repair queued
Att 16-Opioid Call-Back Survey Alternate Methods.docx Supplementary Document Uploaded 2019-06-20 Repair queued
Att 15-PRAMS Live Birth Sample Size by Jurisdiction.xlsx Supplementary Document Uploaded 2019-06-20 Repair queued
Att 14-PRAMS IRB approval_19.docx Supplementary Document Uploaded 2019-06-20 Repair queued
Att 5-PIDS Privacy Impact Assessment.pdf Supplementary Document Uploaded 2019-06-20 Repair queued
Att 4-PRAMS Response Incentives and Rewards by State_rev_080118.docx Supplementary Document Uploaded 2019-06-20 Repair queued
Att 3-PRAMS Questionnaire Development Process.docx Supplementary Document Uploaded 2019-06-20 Available
Att 2b_Response to Public Comments on 60 Day FRN.pdf Supplementary Document Uploaded 2019-06-20 Repair queued
Att 2a-Published 60 Day FRN.pdf Supplementary Document Uploaded 2019-06-20 Repair queued
Att 1c-PREEMIE ACT.pdf Supplementary Document Uploaded 2019-06-20 Repair queued
Att 1b-SMART ACT.pdf Supplementary Document Uploaded 2019-06-20 Repair queued
Att 1a-Section 301 of the Public Health Service Act (42 U.S.C. 241).docx Supplementary Document Uploaded 2019-06-20 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
236591 PRAMS Stillbirth Survey Form and Instruction Unchanged
236590 PRAMS Field Test Form and Instruction Unchanged
236589 PRAMS Opioid Call-back Surveys Form and Instruction Unchanged
236588 PRAMS Supplemental Modules Form and Instruction Unchanged
236587 PRAMS Phase 8 Questionnaire (Core Questions plus State-selected Standard Modules) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
11/30/2022 11/30/2022
117,594 117,594
29,766 29,766
730,438 730,438





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
PRAMS Field Test n/a PRAMS Field Testing
PRAMS Opioid Call-back Surveys n/a, n/a PRAMS Opioid Call-back Survey (English) ,   PRAMS Opioid Call-back Survey (Spanish)
PRAMS Phase 8 Questionnaire (Core Questions plus State-selected Standard Modules) 0920-1273, n/a, n/a, n/a, n/a, n/a, n/a, n/a, n/a, 0920-1273, 0920-1273, 0920-1273, 0920-1273 PRAMS Livebirth Core Phase 8 Mail Questionnaire (English) ,   PRAMS Livebirth Core Phase 8 Mail Questionnaire (Spanish) ,   PRAMS Livebirth Core Phase 8 Phone Questionnaire (English) ,   PRAMS Livebirth Core Phase 8 Phone Questionnaire (Spanish) ,   PRAMS Livebirth Standard Phase 8 Mail Modules (English) ,   PRAMS Livebirth Standard Phase 8 Mail Modules (Spanish) ,   PRAMS Livebirth Standard Phase 8 Phone Modules (English) ,   PRAMS Livebirth Standard Phase 8 Phone Modules (Spanish) ,   Maryland PRAMS Grantee Web Questionnaire ,   Puerto Rico PRAMS Grantee Web Questionnaire ,   South Carolina PRAMS Grantee Web Questionnaire ,   Virginia PRAMS Grantee Web Questionnaire ,   Wyoming PRAMS Grantee Web Questionnaire
PRAMS Stillbirth Survey n/a, n/a, n/a, n/a PRAMS Stillbirth Mail Questionnaire (English) ,   PRAMS Stillbirth Mail Questionnaire (Spanish) ,   PRAMS Stillbirth Phone Questionnaire (English) ,   PRAMS Stillbirth Phone Questionnaire (Spanish)
PRAMS Supplemental Modules n/a, n/a, n/a Family History of Breast and Ovarian Cancer Supplement ,   Prescription and Illicit Opioid Use Supplement ,   Disabilities Supplement

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 117,594 117,594 0 0 0 0
Annual Time Burden (Hours) 29,766 29,766 0 0 0 0
Annual Cost Burden (Dollars) 730,438 730,438 0 0 0 0


Reginfo record details
  No