PRAMS Supplemental Modules

[NCCDPHP] Pregnancy Risk Assessment Monitoring System (PRAMS)

OMB: 0920-1273

IC ID: 236588

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

PRAMS Supplemental 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 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

Health Public Health Monitoring

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

52,984 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 52,984 0 0 0 0 52,984
Annual IC Time Burden (Hours) 7,065 0 0 0 0 7,065
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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