Information Collection

PRAMS Field Test

IC 236590 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⚠️ Notice: This information collection may be referencing outdated material.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 Field Test	Form and Instruction
PRAMS Field Testing Questionnaire (English and Spanish) Att 15b - PRAMS Field Testing Questionnaire English and Spanish.docx	Form and Instruction
PRAMS Field Testing Questionnaire (English and Spanish) Att 15b - PRAMS Field Testing Questionnaire English and Spanish.docx	Form and Instruction
Att 15c - PRAMS Field Testing Questionnaire Informed Consent_ENGLISH.docx PRAMS Field Testing Questionnaire Informed Consent (English)	IC Document
Att 15c - PRAMS Field Testing Questionnaire Informed Consent_ENGLISH.docx PRAMS Field Testing Questionnaire Informed Consent (English)	IC Document
Att 15d - PRAMS Field Testing Questionnaire Informed Consent_SPANISH.docx PRAMS Field Testing Questionnaire Informed Consent (Spanish)	IC Document
Att 15d - PRAMS Field Testing Questionnaire Informed Consent_SPANISH.docx PRAMS Field Testing Questionnaire Informed Consent (Spanish)	IC Document

IC Title:

PRAMS Field Test

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	None	PRAMS Field Testing Questionnaire (English and Spanish)	Att 15b - PRAMS Field Testing Questionnaire English and Spanish.docx		No		Paper Only

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	150	0	150
Annual IC Time Burden (Hours)	100	50	50
Annual IC Cost Burden (Dollars)	0	-1,227	1,227

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PRAMS Field Testing Questionnaire Informed Consent (English)	Att 15c - PRAMS Field Testing Questionnaire Informed Consent_ENGLISH.docx	11/29/2022
PRAMS Field Testing Questionnaire Informed Consent (Spanish)	Att 15d - PRAMS Field Testing Questionnaire Informed Consent_SPANISH.docx	11/29/2022

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