Document Name Document Type
PRAMS Supplemental Modules Form and Instruction
PRAMS Social Determinants of Health Supplement (mail and phone) Att 11a - PRAMS Social Determinants of Health Supplement_English_Spanish_Mail and Phone.docx Form and Instruction
PRAMS Social Determinants of Health Supplement (web mode) Att 11b - PRAMS Social Determinants of Health Supplement_English and Spanish Web.docx Form and Instruction
PRAMS COVID-19 Vaccine Supplement (mail and phone) Att 11c- PRAMS COVID-19 Vaccine Supplement_English and Spanish_Mail and Phone.docx Form and Instruction
PRAMS COVID-19 Vaccine Supplement (web mode) Att 11d - PRAMS COVID-19 Vaccine Supplement_English and Spanish Web.docx Form and Instruction
PRAMS COVID-19 Experience Supplement (mail and phone) Att 11e - PRAMS COVID-19 Experience Supplement_English and Spanish_Mail and Phone.docx Form and Instruction
PRAMS COVID-19 Experience Supplement (web mode) Att 11f - PRAMS COVID-19 Experience Supplement English and Spanish Web.docx Form and Instruction
PRAMS Opioid Use Supplement (mail and phone) Att 11g - PRAMS Opioid Use Supplement_English and Spanish_Mail and Phone.docx Form and Instruction
PRAMS Opioid Use Supplement (web mode) Att 11h - PRAMS Opioid Use Supplement_English and Spanish Web.docx Form and Instruction
PRAMS Marijuana Use Supplement (mail and phone) Att 11i - PRAMS Marijuana Use Supplement_English and Spanish_Mail and Phone.docx Form and Instruction
PRAMS Marijuana Use Supplement (web mode) Att 11j - PRAMS Marijuana Use Supplement English and Spanish Web.docx Form and Instruction
PRAMS Disabilities Supplement (mail and phone) Att 11k- PRAMS Disabilities Supplement_English and Spanish_Mail and Phone.docx Form and Instruction
PRAMS Disabilities Supplement (web mode) Att 11l - PRAMS Disabilities Supplement_English and Spanish Web.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PRAMS Supplemental Modules	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	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

Federal Enterprise Architecture Business Reference Module

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: 52,984	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 34 %

	Requested	Previously Approved
Annual Number of Responses for this IC	52,984	52,984
Annual IC Time Burden (Hours)	7,065	7,065
Annual IC Cost Burden (Dollars)	0	0

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.

PRAMS Supplemental Modules

[NCCDPHP] Pregnancy Risk Assessment Monitoring System (PRAMS)

OMB: 0920-1273

IC ID: 236588

View Information Collection (IC)