PRAMS Phase 8 Questionnaire (Core Questions plus State-selected Standard Modules)

Pregnancy Risk Assessment Monitoring System (PRAMS)

OMB: 0920-1273

IC ID: 236587

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Reference Material: Phase 8 Co
Other-Reference Material: Phase 8 Co
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
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Form
Form
Form
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Form
Form
Form
Form
Form
IC Document
IC Document
IC Document
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IC Document
Information Collection (IC) Details

View Information Collection (IC)

PRAMS Phase 8 Questionnaire (Core Questions plus State-selected Standard Modules)
 
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 Livebirth Core Phase 8 Mail Questionnaire (English) Att 7a-PRAMS Phase 8 Core LiveBirth_Mail_ENGLISH.docx No   Paper Only
Form and Instruction n/a PRAMS Livebirth Core Phase 8 Mail Questionnaire (Spanish) Att 7b-PRAMS Phase 8 Core LiveBirth_Mail_SPANISH.docx No   Paper Only
Form and Instruction n/a PRAMS Livebirth Core Phase 8 Phone Questionnaire (English) Att 7c-PRAMS Phase 8 Core_Livebirth_Phone_ENGLISH.docx No   Fillable Fileable
Form and Instruction n/a PRAMS Livebirth Core Phase 8 Phone Questionnaire (Spanish) Att 7d-PRAMS Phase 8 Core_Livebirth_Phone_SPANISH.docx No   Fillable Fileable
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Mail Modules (English) Att 9a-PRAMS Phase 8 Standard Module Questions_Mail_ENGLISH.docx No   Paper Only
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Mail Modules (Spanish) Att 9b-PRAMS Phase 8 Standard Module Questions_Mail_SPANISH.docx No   Paper Only
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Phone Modules (English) Att 9c-PRAMS Phase 8 Standard Module Questions_Phone_ENGLISH.docx No   Paper Only
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Phone Modules (Spanish) Att 9d-PRAMS Phase 8 Standard Module Questions_Phone_SPANISH.docx No   Paper Only
Other-Reference Material: Phase 8 Core and Standard Questions, by Topic Area Att 6-PRAMS Phase 8 Topic Reference Document.docx No   Paper Only
Form 0920-1273 Maryland PRAMS Grantee Web Questionnaire MD_PRAMS_WebSurvey_Final_09032021.pdf Yes Yes Fillable Fileable
Form 0920-1273 Puerto Rico PRAMS Grantee Web Questionnaire PR_PRAMS_WebSurvey_Final_09032021.pdf Yes Yes Fillable Fileable
Form 0920-1273 South Carolina PRAMS Grantee Web Questionnaire SC_PRAMS_WebSurvey_Final_09032021.pdf Yes Yes Fillable Fileable
Form 0920-1273 Virginia PRAMS Grantee Web Questionnaire VA_PRAMS_WebSurvey_Final_09032021.pdf Yes Yes Fillable Fileable
Form 0920-1273 Wyoming PRAMS Grantee Web Questionnaire WY_PRAMS_WebSurvey_Final_09032021.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

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

52,070 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 52,070 0 0 0 0 52,070
Annual IC Time Burden (Hours) 22,564 0 0 0 0 22,564
Annual IC Cost Burden (Dollars) 553,712 0 0 0 0 553,712

Title Document Date Uploaded
PRAMS Livebirth Introduction and Informed Consent for Mail Survey (English) Att 12a-PRAMS Livebirth Introduction and Informed Consent Mail_English.doc 06/20/2019
PRAMS Livebirth Introduction and Informed Consent for Mail Survey (Spanish) Att 12b-PRAMS Livebirth Introduction and Informed Consent Mail_Spanish.doc 06/20/2019
PRAMS Livebirth Introduction and Informed Consent for Phone Survey (English) Att 12e-PRAMS Livebirth Introduction and Informed Consent Phone _English.docx 06/20/2019
PRAMS Livebirth Introduction and Informed Consent for Phone Survey (Spanish) Att 12f-PRAMS Livebirth 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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