Information Collection

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

IC 236587 under ICR 202203-0920-012 · OMB 0920-1273.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PRAMS Phase 8 Questionnaire (Core Questions plus State-selected Standard Modules)	Form and Instruction
Att 6-PRAMS Phase 8 Topic Reference Document.docx	Other-Reference Material: Phase 8 Co
Att 6-PRAMS Phase 8 Topic Reference Document.docx	Other-Reference Material: Phase 8 Co
PRAMS Livebirth Core Phase 8 Mail Questionnaire (English Att 7a-PRAMS Phase 8 Core LiveBirth_Mail_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Core Phase 8 Mail Questionnaire (English Att 7a-PRAMS Phase 8 Core LiveBirth_Mail_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Core Phase 8 Mail Questionnaire (Spanish Att 7b-PRAMS Phase 8 Core LiveBirth_Mail_SPANISH.docx	Form and Instruction
PRAMS Livebirth Core Phase 8 Mail Questionnaire (Spanish Att 7b-PRAMS Phase 8 Core LiveBirth_Mail_SPANISH.docx	Form and Instruction
PRAMS Livebirth Core Phase 8 Phone Questionnaire (Englis Att 7c-PRAMS Phase 8 Core_Livebirth_Phone_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Core Phase 8 Phone Questionnaire (Englis Att 7c-PRAMS Phase 8 Core_Livebirth_Phone_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Core Phase 8 Phone Questionnaire (Spanis Att 7d-PRAMS Phase 8 Core_Livebirth_Phone_SPANISH.docx	Form and Instruction
PRAMS Livebirth Core Phase 8 Phone Questionnaire (Spanis Att 7d-PRAMS Phase 8 Core_Livebirth_Phone_SPANISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Mail Modules (English) Att 9a-PRAMS Phase 8 Standard Module Questions_Mail_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Mail Modules (English) Att 9a-PRAMS Phase 8 Standard Module Questions_Mail_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Mail Modules (Spanish) Att 9b-PRAMS Phase 8 Standard Module Questions_Mail_SPANISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Mail Modules (Spanish) Att 9b-PRAMS Phase 8 Standard Module Questions_Mail_SPANISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Phone Modules (English) Att 9c-PRAMS Phase 8 Standard Module Questions_Phone_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Phone Modules (English) Att 9c-PRAMS Phase 8 Standard Module Questions_Phone_ENGLISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Phone Modules (Spanish) Att 9d-PRAMS Phase 8 Standard Module Questions_Phone_SPANISH.docx	Form and Instruction
PRAMS Livebirth Standard Phase 8 Phone Modules (Spanish) Att 9d-PRAMS Phase 8 Standard Module Questions_Phone_SPANISH.docx	Form and Instruction
0920-1273 Maryland PRAMS Grantee Web Questionnaire MD_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 Maryland PRAMS Grantee Web Questionnaire MD_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 Puerto Rico PRAMS Grantee Web Questionnaire PR_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 Puerto Rico PRAMS Grantee Web Questionnaire PR_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 South Carolina PRAMS Grantee Web Questionnaire SC_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 South Carolina PRAMS Grantee Web Questionnaire SC_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 Virginia PRAMS Grantee Web Questionnaire VA_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 Virginia PRAMS Grantee Web Questionnaire VA_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 Wyoming PRAMS Grantee Web Questionnaire WY_PRAMS_WebSurvey_Final_09032021.pdf	Form
0920-1273 Wyoming PRAMS Grantee Web Questionnaire WY_PRAMS_WebSurvey_Final_09032021.pdf	Form
Att 12a-PRAMS Livebirth Introduction and Informed Consent Mail_English.doc PRAMS Livebirth Introduction and Informed Consent for Mail Survey (English)	IC Document
Att 12a-PRAMS Livebirth Introduction and Informed Consent Mail_English.doc PRAMS Livebirth Introduction and Informed Consent for Mail Survey (English)	IC Document
Att 12b-PRAMS Livebirth Introduction and Informed Consent Mail_Spanish.doc PRAMS Livebirth Introduction and Informed Consent for Mail Survey (Spanish)	IC Document
Att 12b-PRAMS Livebirth Introduction and Informed Consent Mail_Spanish.doc PRAMS Livebirth Introduction and Informed Consent for Mail Survey (Spanish)	IC Document
Att 12e-PRAMS Livebirth Introduction and Informed Consent Phone _English.docx PRAMS Livebirth Introduction and Informed Consent for Phone Survey (English)	IC Document
Att 12e-PRAMS Livebirth Introduction and Informed Consent Phone _English.docx PRAMS Livebirth Introduction and Informed Consent for Phone Survey (English)	IC Document
Att 12f-PRAMS Livebirth Introduction and Informed Consent Phone _Spanish.docx PRAMS Livebirth Introduction and Informed Consent for Phone Survey (Spanish)	IC Document
Att 12f-PRAMS Livebirth Introduction and Informed Consent Phone _Spanish.docx PRAMS Livebirth Introduction and Informed Consent for Phone Survey (Spanish)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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

Federal Enterprise Architecture Business Reference Module

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: 52,070

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	52,070	52,070
Annual IC Time Burden (Hours)	22,564	22,564
Annual IC Cost Burden (Dollars)	553,712	553,712

Documents for IC

table that charts IC Documents
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.