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

[NCCDPHP] Pregnancy Risk Assessment Monitoring System (PRAMS)

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 (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: Unchanged

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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,790	2,790
Annual IC Time Burden (Hours)	1,395	1,395
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.