Information Collection

PRAMS Call-back Surveys (with Opioid Call-back Survey Example)

IC 236589 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⚠️ Notice: This information collection may be referencing outdated material.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 Call-back Surveys (with Opioid Call-back Survey Example)	Form and Instruction
PRAMS Opioid Call-back Survey (English) Att 11a-PRAMS Opioid Call Back Survey_DRAFT_PHONE_ENGLISH_040819.docx	Form and Instruction
PRAMS Opioid Call-back Survey (English) Att 11a-PRAMS Opioid Call Back Survey_DRAFT_PHONE_ENGLISH_040819.docx	Form and Instruction
PRAMS Opioid Call-back Survey (Spanish) Att 11b-PRAMS Opioid Call Back Survey_DRAFT_PHONE_SPANISH_040819.docx	Form and Instruction
PRAMS Opioid Call-back Survey (Spanish) Att 11b-PRAMS Opioid Call Back Survey_DRAFT_PHONE_SPANISH_040819.docx	Form and Instruction

IC Title:

PRAMS Call-back Surveys (with Opioid Call-back Survey Example)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	PRAMS Opioid Call-back Survey (English)	Att 11a-PRAMS Opioid Call Back Survey_DRAFT_PHONE_ENGLISH_040819.docx		No		Paper Only
Form and Instruction	n/a	PRAMS Opioid Call-back Survey (Spanish)	Att 11b-PRAMS Opioid Call Back Survey_DRAFT_PHONE_SPANISH_040819.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0160

FR Citation: 51 FR 42484

Number of Respondents: 2,790

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,790	-1,171	3,961
Annual IC Time Burden (Hours)	1,395	-586	1,981
Annual IC Cost Burden (Dollars)	0	-48,601	48,601

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.