Information Collection

PRAMS Supplemental Modules

IC 236588 under ICR 202211-0920-018 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Supplemental Modules	Form and Instruction
PRAMS Social Determinants of Health Supplement (mail and Att 11a - PRAMS Social Determinants of Health Supplement_English_Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Social Determinants of Health Supplement (mail and Att 11a - PRAMS Social Determinants of Health Supplement_English_Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Social Determinants of Health Supplement (web mode Att 11b - PRAMS Social Determinants of Health Supplement_English and Spanish Web.docx	Form and Instruction
PRAMS Social Determinants of Health Supplement (web mode Att 11b - PRAMS Social Determinants of Health Supplement_English and Spanish Web.docx	Form and Instruction
PRAMS COVID-19 Vaccine Supplement (mail and phone) Att 11c- PRAMS COVID-19 Vaccine Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS COVID-19 Vaccine Supplement (mail and phone) Att 11c- PRAMS COVID-19 Vaccine Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS COVID-19 Vaccine Supplement (web mode) Att 11d - PRAMS COVID-19 Vaccine Supplement_English and Spanish Web.docx	Form and Instruction
PRAMS COVID-19 Vaccine Supplement (web mode) Att 11d - PRAMS COVID-19 Vaccine Supplement_English and Spanish Web.docx	Form and Instruction
PRAMS COVID-19 Experience Supplement (mail and phone) Att 11e - PRAMS COVID-19 Experience Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS COVID-19 Experience Supplement (mail and phone) Att 11e - PRAMS COVID-19 Experience Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS COVID-19 Experience Supplement (web mode) Att 11f - PRAMS COVID-19 Experience Supplement English and Spanish Web.docx	Form and Instruction
PRAMS COVID-19 Experience Supplement (web mode) Att 11f - PRAMS COVID-19 Experience Supplement English and Spanish Web.docx	Form and Instruction
PRAMS Opioid Use Supplement (mail and phone) Att 11g - PRAMS Opioid Use Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Opioid Use Supplement (mail and phone) Att 11g - PRAMS Opioid Use Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Opioid Use Supplement (web mode) Att 11h - PRAMS Opioid Use Supplement_English and Spanish Web.docx	Form and Instruction
PRAMS Opioid Use Supplement (web mode) Att 11h - PRAMS Opioid Use Supplement_English and Spanish Web.docx	Form and Instruction
PRAMS Marijuana Use Supplement (mail and phone) Att 11i - PRAMS Marijuana Use Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Marijuana Use Supplement (mail and phone) Att 11i - PRAMS Marijuana Use Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Marijuana Use Supplement (web mode) Att 11j - PRAMS Marijuana Use Supplement English and Spanish Web.docx	Form and Instruction
PRAMS Marijuana Use Supplement (web mode) Att 11j - PRAMS Marijuana Use Supplement English and Spanish Web.docx	Form and Instruction
PRAMS Disabilities Supplement (mail and phone) Att 11k- PRAMS Disabilities Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Disabilities Supplement (mail and phone) Att 11k- PRAMS Disabilities Supplement_English and Spanish_Mail and Phone.docx	Form and Instruction
PRAMS Disabilities Supplement (web mode) Att 11l - PRAMS Disabilities Supplement_English and Spanish Web.docx	Form and Instruction
PRAMS Disabilities Supplement (web mode) Att 11l - PRAMS Disabilities Supplement_English and Spanish Web.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

PRAMS Supplemental Modules

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	None	PRAMS Social Determinants of Health Supplement (mail and phone)	Att 11a - PRAMS Social Determinants of Health Supplement_English_Spanish_Mail and Phone.docx	No		Paper Only
Form and Instruction	None	PRAMS Social Determinants of Health Supplement (web mode)	Att 11b - PRAMS Social Determinants of Health Supplement_English and Spanish Web.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	PRAMS COVID-19 Vaccine Supplement (mail and phone)	Att 11c- PRAMS COVID-19 Vaccine Supplement_English and Spanish_Mail and Phone.docx	No		Paper Only
Form and Instruction	None	PRAMS COVID-19 Vaccine Supplement (web mode)	Att 11d - PRAMS COVID-19 Vaccine Supplement_English and Spanish Web.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	PRAMS COVID-19 Experience Supplement (mail and phone)	Att 11e - PRAMS COVID-19 Experience Supplement_English and Spanish_Mail and Phone.docx	No		Paper Only
Form and Instruction	None	PRAMS COVID-19 Experience Supplement (web mode)	Att 11f - PRAMS COVID-19 Experience Supplement English and Spanish Web.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	PRAMS Opioid Use Supplement (mail and phone)	Att 11g - PRAMS Opioid Use Supplement_English and Spanish_Mail and Phone.docx	No		Paper Only
Form and Instruction	None	PRAMS Opioid Use Supplement (web mode)	Att 11h - PRAMS Opioid Use Supplement_English and Spanish Web.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	PRAMS Marijuana Use Supplement (mail and phone)	Att 11i - PRAMS Marijuana Use Supplement_English and Spanish_Mail and Phone.docx	No		Paper Only
Form and Instruction	None	PRAMS Marijuana Use Supplement (web mode)	Att 11j - PRAMS Marijuana Use Supplement English and Spanish Web.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	PRAMS Disabilities Supplement (mail and phone)	Att 11k- PRAMS Disabilities Supplement_English and Spanish_Mail and Phone.docx	No		Paper Only
Form and Instruction	None	PRAMS Disabilities Supplement (web mode)	Att 11l - PRAMS Disabilities Supplement_English and Spanish Web.docx	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: 52,984

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 34 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	52,984	-39,769	92,753
Annual IC Time Burden (Hours)	7,065	-1,914	8,979
Annual IC Cost Burden (Dollars)	0	-220,344	220,344

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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