PRAMS Field Test

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⚠️ Notice: This information collection may be referencing outdated material.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 Field Test Form and Instruction
PRAMS Field Testing Att 18-Field Testing Questionnaire.docx Form and Instruction
PRAMS Field Testing Att 18-Field Testing Questionnaire.docx Form and Instruction
Att19a-PRAMS Field Testing Questionnaire Informed Consent_English.docx Informed Consent for Field Test (English) IC Document
Att19a-PRAMS Field Testing Questionnaire Informed Consent_English.docx Informed Consent for Field Test (English) IC Document
Att19b-PRAMS Field Testing Questionnaire Informed Consent_Spanish.docx Informed Consent for Field Test (Spanish) IC Document
Att19b-PRAMS Field Testing Questionnaire Informed Consent_Spanish.docx Informed Consent for Field Test (Spanish) IC Document

Information Collection (IC) Details

IC Title:	PRAMS Field Test	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 Field Testing	Att 18-Field Testing Questionnaire.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160 Records of Subjects in Health Promotion and Education Studies	FR Citation: 51 FR 42484

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	1,227	1,227

Documents for IC

Title	Document	Date Uploaded
Informed Consent for Field Test (English)	Att19a-PRAMS Field Testing Questionnaire Informed Consent_English.docx	06/20/2019
Informed Consent for Field Test (Spanish)	Att19b-PRAMS Field Testing Questionnaire Informed Consent_Spanish.docx	06/20/2019

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