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

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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

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.