PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules)

[NCCDPHP] Pregnancy Risk Assessment Monitoring System (PRAMS)

OMB: 0920-1273

IC ID: 236587

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Information Collection (IC) Details

View Information Collection (IC)

PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules)
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None PRAMS Phase 8 Web Survey - MD Att 2a - PRAMS Phase 8 Web Survey - MD.pdf Yes Yes Fillable Fileable
Form and Instruction None PRAMS Phase 8 Web Survey - PR Att 2b - PRAMS Phase 8 Web Survey - PR.pdf Yes Yes Fillable Fileable
Form and Instruction None PRAMS Phase 8 Web Survey - SC Att 2c - PRAMS Phase 8 Web Survey - SC.pdf Yes Yes Fillable Fileable
Form and Instruction None PRAMS Phase 8 Web Survey - VA Att 2d - PRAMS Phase 8 Web Survey - VA.pdf Yes Yes Fillable Fileable
Form and Instruction None PRAMS Phase 8 Web Survey - WY Att 2e - PRAMS Phase 8 Web Survey - WY.pdf Yes Yes Fillable Fileable
Form and Instruction None PRAMS Livebirth Phase 8 Core Mail Questionnaire (English) Att 8a - PRAMS Livebirth Phase 8 Core Mail Questionnaire_ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 8 Core Mail Questionnaire (Spanish) Att 8b - PRAMS Livebirth Phase 8 Core Mail Questionnaire_SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 8 Core Phone Questionnaire (English) Att 8c - PRAMS Livebirth Phase 8 Core Phone Questionnaire_ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 8 Core Phone Questionnaire (English) Att 8d - PRAMS Livebirth Phase 8 Core Phone Questionnaire_SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Core Mail Questionnaire (English) Att 8e - PRAMS Livebirth Phase 9 Core Mail Questionnaire - ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Core Mail Questionnaire (Spanish) Att 8f - PRAMS Livebirth Phase 9 Core Mail Questionnaire_SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Core Phone Questionnaire (English) Att 8g - PRAMS Livebirth Phase 9 Core Phone Questionnaire - ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Core Phone Questionnaire (Spanish) Att 8h - PRAMS Livebirth Phase 9 Core Phone Questionnaire - SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Core Web Questionnaire (English) Att 8i - PRAMS Livebirth Phase 9 Core Web Questionnaire - ENGLISH.docx Yes Yes Fillable Fileable
Form and Instruction None PRAMS Livebirth Phase 9 Core Web Questionnaire (Spanish) Att 8j - PRAMS Livebirth Phase 9 Core Web Questionniare - SPANISH.docx Yes Yes Fillable Fileable
Form and Instruction None PRAMS Livebirth Phase 8 Standard Mail Modules (English) Att 10a - PRAMS Livebirth Phase 8 Standard Mail Module_ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 8 Standard Mail Modules (Spanish) Att 10b - PRAMS Livebirth Phase 8 Standard Mail Module_SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 8 Standard Phone Module (English) Att 10c - PRAMS Livebirth Phase 8 Standard Phone Module_ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 8 Standard Phone Module (Spanish) Att 10d - PRAMS Livebirth Phase 8 Standard Phone Module_SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Standard Mail Questionnaire (English) Att 10e - PRAMS Livebirth Phase 9 Standard Mail Questionnaire - ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Standard Mail Questionnaire (Spanish) Att 10f - PRAMS Livebirth Phase 9 Standard Mail Questionnaire_SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Standard Phone Questionnaire (English) Att 10g - PRAMS Livebirth Phase 9 Standard Phone Questionnaire_ENGLISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Standard Phone Questionnaire (Spanish) Att 10h - PRAMS Livebirth Phase 9 Standard Phone Questionnaire_SPANISH.docx No   Paper Only
Form and Instruction None PRAMS Livebirth Phase 9 Standard Web Module (English) Att 10i - PRAMS Livebirth Phase 9 Standard Web Module - ENGLISH.docx Yes Yes Fillable Fileable
Form and Instruction None PRAMS Livebirth Phase 9 Standard Web Module (Spanish) Att 10j - PRAMS Livebirth Phase 9 Standard Web Module - SPANISH.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0160 Records of Subjects in Health Promotion and Education Studies  51 FR 42484

51,556 0
   
Individuals or Households
 
   34 %

  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 51,556 0 0 0 0 51,556
Annual IC Time Burden (Hours) 22,341 0 0 0 0 22,341
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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