OMB
.report
Search
PRAMS Field Test
Pregnancy Risk Assessment Monitoring System (PRAMS)
OMB: 0920-1273
IC ID: 236590
OMB.report
HHS/CDC
OMB 0920-1273
ICR 202203-0920-012
IC 236590
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1273 can be found here:
2023-05-26 - No material or nonsubstantive change to a currently approved collection
2022-11-30 - Revision of a currently approved collection
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
View Information Collection (IC)
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
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:
150
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
150
0
0
0
0
150
Annual IC Time Burden (Hours)
50
0
0
0
0
50
Annual IC Cost Burden (Dollars)
1,227
0
0
0
0
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.