Information Collection Request

[NCCDPHP] Pregnancy Risk Assessment Monitoring System (PRAMS)

ICR 202504-0920-014 · OMB 0920-1273 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
PRAMS Stillbirth Phone Questionnaire (Spanish) Form and Instruction Unchanged Available
PRAMS Stillbirth Phone Questionnaire (English) Form and Instruction Unchanged Available
PRAMS Stillbirth Mail Questionnaire (Spanish) Form and Instruction Unchanged Repair queued
PRAMS Stillbirth Mail Questionnaire (English) Form and Instruction Unchanged Available
PRAMS Stillbirth Survey Form and Instruction Unchanged Repair queued
PRAMS Field Testing Questionnaire (English and Spanish) Form and Instruction Unchanged Available
PRAMS Field Test Form and Instruction Unchanged Repair queued
PRAMS Opioid Call-back Survey (Spanish) Form and Instruction Unchanged Repair queued
PRAMS Opioid Call-back Survey (English) Form and Instruction Unchanged Available
PRAMS Call-back Surveys (with Opioid Call-back Survey Example) Form and Instruction Unchanged Repair queued
PRAMS Disabilities Supplement (web mode) Form and Instruction Unchanged Available
PRAMS Disabilities Supplement (mail and phone) Form and Instruction Unchanged Available
PRAMS Marijuana Use Supplement (web mode) Form and Instruction Unchanged Repair queued
PRAMS Marijuana Use Supplement (mail and phone) Form and Instruction Unchanged Available
PRAMS Opioid Use Supplement (web mode) Form and Instruction Unchanged Repair queued
PRAMS Opioid Use Supplement (mail and phone) Form and Instruction Unchanged Available
PRAMS COVID-19 Experience Supplement (web mode) Form and Instruction Unchanged Available
PRAMS COVID-19 Experience Supplement (mail and phone) Form and Instruction Unchanged Available
PRAMS COVID-19 Vaccine Supplement (web mode) Form and Instruction Unchanged Repair queued
PRAMS COVID-19 Vaccine Supplement (mail and phone) Form and Instruction Unchanged Available
PRAMS Social Determinants of Health Supplement (web mode) Form and Instruction Unchanged Repair queued
PRAMS Social Determinants of Health Supplement (mail and phone) Form and Instruction Unchanged Available
PRAMS Supplemental Modules Form and Instruction Unchanged Repair queued
Form 0920-25-0092 PRAMS Livebirth Phase 9 Standard Web Module (Spanish) Form and Instruction Modified Available
Form 0920-25-0092 PRAMS Livebirth Phase 9 Standard Web Module (English) Form and Instruction Modified Available
Form 0920-25-0092 PRAMS Livebirth Phase 9 Standard Phone Questionnaire (Spanish) Form and Instruction Modified Repair queued
Form 0920-25-0092 PRAMS Livebirth Phase 9 Standard Phone Questionnaire (English) Form and Instruction Modified Available
Form 0920-25-0092 PRAMS Livebirth Phase 9 Standard Mail Questionnaire (Spanish) Form and Instruction Modified Repair queued
Form 0920-25-0092 PRAMS Livebirth Phase 9 Standard Mail Questionnaire (English) Form and Instruction Modified Available
PRAMS Livebirth Phase 8 Standard Phone Module (Spanish) Form and Instruction Modified Available
PRAMS Livebirth Phase 8 Standard Phone Module (English) Form and Instruction Modified Available
PRAMS Livebirth Phase 8 Standard Mail Modules (Spanish) Form and Instruction Modified Available
PRAMS Livebirth Phase 8 Standard Mail Modules (English) Form and Instruction Modified Repair queued
Form 0920-25-0092 PRAMS Livebirth Phase 9 Core Web Questionnaire (Spanish) Form and Instruction Modified Available
Form 0920-25-0092 PRAMS Livebirth Phase 9 Core Web Questionnaire (English) Form and Instruction Modified Repair queued
Form 0920-25-0092 PRAMS Livebirth Phase 9 Core Phone Questionnaire (Spanish) Form and Instruction Modified Available
Form 0920-25-0092 PRAMS Livebirth Phase 9 Core Phone Questionnaire (English) Form and Instruction Modified Repair queued
Form 0920-25-0092 PRAMS Livebirth Phase 9 Core Mail Questionnaire (Spanish) Form and Instruction Modified Repair queued
Form 0920-25-0092 PRAMS Livebirth Phase 9 Core Mail Questionnaire (English) Form and Instruction Modified Available
PRAMS Livebirth Phase 8 Core Phone Questionnaire (English) Form and Instruction Modified Repair queued
PRAMS Livebirth Phase 8 Core Phone Questionnaire (English) Form and Instruction Modified Available
PRAMS Livebirth Phase 8 Core Mail Questionnaire (Spanish) Form and Instruction Modified Repair queued
PRAMS Livebirth Phase 8 Core Mail Questionnaire (English) Form and Instruction Modified Available
PRAMS Phase 8 Web Survey - WY Form and Instruction Modified Available
PRAMS Phase 8 Web Survey - VA Form and Instruction Modified Available
PRAMS Phase 8 Web Survey - SC Form and Instruction Modified Available
PRAMS Phase 8 Web Survey - PR Form and Instruction Modified Available
PRAMS Phase 8 Web Survey - MD Form and Instruction Modified Available
PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction Modified Repair queued
OMB_Change Request_0920_1273_PRAMS_04_10_25.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-04-16 Repair queued
OMB_Change Request_0920_1273_PRAMS_04_10_25.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-04-16 Repair queued
OMB_Change Request_PRAMS 11-13-24.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-11-21 Available
OMB_Change Request_PRAMS 11-13-24.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-11-21 Repair queued
Att 17 - PRAMS Phase 9 Cognitive Testing Report.pdf Supplementary Document Uploaded 2023-05-25 Available
Att 17 - PRAMS Phase 9 Cognitive Testing Report.pdf Supplementary Document Uploaded 2023-05-25 Repair queued
0920-1273 Response to Terms of Clearance _05_23_2023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-05-25 Available
0920-1273 Response to Terms of Clearance _05_23_2023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-05-25 Repair queued
FINAL for signature - Stacey Y Brayboy_March of Dimes - CAPS 00264282_signed.docx Supplementary Document Uploaded 2023-05-25 Repair queued
FINAL for signature - Stacey Y Brayboy_March of Dimes - CAPS 00264282_signed.docx Supplementary Document Uploaded 2023-05-25 Repair queued
Attachment 19a. Nonresponse Bias Assessment of 2020 and 2021 Data.docx Supplementary Document Uploaded 2024-11-21 Available
Attachment 19a. Nonresponse Bias Assessment of 2020 and 2021 Data.docx Supplementary Document Uploaded 2024-11-21 Repair queued
Att 18 - PRAMS Phase 9 Field Testing Report.pdf Supplementary Document Uploaded 2023-03-22 Available
Att 18 - PRAMS Phase 9 Field Testing Report.pdf Supplementary Document Uploaded 2023-03-22 Repair queued
Att 2f - PRAMS Phase 8 Web Mode Data Collection Metrics_03132023.docx Supplementary Document Uploaded 2023-03-22 Available
Att 2f - PRAMS Phase 8 Web Mode Data Collection Metrics_03132023.docx Supplementary Document Uploaded 2023-03-22 Repair queued
Att 16 Summary of Changes between Phase 8 and 9.docx Supplementary Document Uploaded 2022-11-29 Available
Att 16 Summary of Changes between Phase 8 and 9.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 15a - PRAMS Field Testing Methodology _03 13 2023 clean.docx Supplementary Document Uploaded 2023-03-22 Available
Att 15a - PRAMS Field Testing Methodology _03 13 2023 clean.docx Supplementary Document Uploaded 2023-03-22 Repair queued
Att 14 - PRAMS Live Birth Sample Size by Jurisdiction.xlsx Supplementary Document Uploaded 2022-11-29 Available
Att 14 - PRAMS Live Birth Sample Size by Jurisdiction.xlsx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 13 - PRAMS IRB Approval_2022.docx Supplementary Document Uploaded 2022-11-29 Available
Att 13 - PRAMS IRB Approval_2022.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12j - Livebirth Web Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12j - Livebirth Web Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Missing upstream
Att 12i - PRAMS Livebirth Web Introduction and Informed Consent - ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12i - PRAMS Livebirth Web Introduction and Informed Consent - ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12h - Stillbirth Phone Introduction and Informed Consent_SPANISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12h - Stillbirth Phone Introduction and Informed Consent_SPANISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12g - Stillbirth Phone Introduction and Informed Consent_ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12g - Stillbirth Phone Introduction and Informed Consent_ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12f - PRAMS Livebirth Phone Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12f - PRAMS Livebirth Phone Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12e - PRAMS Livebirth Phone Introduction and Informed Consent - ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12e - PRAMS Livebirth Phone Introduction and Informed Consent - ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12d - Stillbirth Mail Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12d - Stillbirth Mail Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12c - Stillbirth Mail Introduction and Informed Consent_ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12c - Stillbirth Mail Introduction and Informed Consent_ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12b - PRAMS Livebirth Mail Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12b - PRAMS Livebirth Mail Introduction and Informed Consent - SPANISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 12a - PRAMS Livebirth Mail Introduction and Informed Consent - ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Available
Att 12a - PRAMS Livebirth Mail Introduction and Informed Consent - ENGLISH.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 7 - PRAMS Livebirth Phase 8 and Phase 9 Questionnaire Topic Reference.docx Supplementary Document Uploaded 2022-11-29 Available
Att 7 - PRAMS Livebirth Phase 8 and Phase 9 Questionnaire Topic Reference.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 6 - PIDS Privacy Impact Assessment.pdf Supplementary Document Uploaded 2022-11-29 Available
Att 6 - PIDS Privacy Impact Assessment.pdf Supplementary Document Uploaded 2022-11-29 Repair queued
Att 5 - PRAMS Response Gifts and Incentives by Jurisdiction 03 13 2023 clean.docx Supplementary Document Uploaded 2023-03-22 Available
Att 5 - PRAMS Response Gifts and Incentives by Jurisdiction 03 13 2023 clean.docx Supplementary Document Uploaded 2023-03-22 Repair queued
Att 4 - PRAMS Questionnaire Development Process.docx Supplementary Document Uploaded 2022-11-29 Available
Att 4 - PRAMS Questionnaire Development Process.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 3b - Program Response to Comments 60 Day FRN.pdf Supplementary Document Uploaded 2022-11-29 Available
Att 3b - Program Response to Comments 60 Day FRN.pdf Supplementary Document Uploaded 2022-11-29 Repair queued
Att 3a - Published 60 Day FRN.pdf Supplementary Document Uploaded 2022-11-29 Repair queued
Att 3a - Published 60 Day FRN.pdf Supplementary Document Uploaded 2022-11-29 Repair queued
Att 1c PREEMIE Reauthorization Act of 2018.pdf Supplementary Document Uploaded 2022-11-29 Available
Att 1c PREEMIE Reauthorization Act of 2018.pdf Supplementary Document Uploaded 2022-11-29 Repair queued
Att 1b Safe Motherhood and Infant Health Authorization.docx Supplementary Document Uploaded 2022-11-29 Available
Att 1b Safe Motherhood and Infant Health Authorization.docx Supplementary Document Uploaded 2022-11-29 Repair queued
Att 1a-Section 301 of the Public Health Service Act (42 U.S.C. 241).docx Supplementary Document Uploaded 2022-11-29 Available
Att 1a-Section 301 of the Public Health Service Act (42 U.S.C. 241).docx Supplementary Document Uploaded 2022-11-29 Missing upstream
PRAMS SS-B_30 Day_11_13_2024_clean.docx Supporting Statement B Uploaded 2024-11-21 Available
PRAMS SS-B_30 Day_11_13_2024_clean.docx Supporting Statement B Uploaded 2024-11-21 Repair queued
1273 PRAMS SSA 04_10_25_clean.docx Supporting Statement A Uploaded 2025-04-16 Available
1273 PRAMS SSA 04_10_25_clean.docx Supporting Statement A Uploaded 2025-04-16 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
257195 Submission of Data File to CDC Instruction Unchanged
236591 PRAMS Stillbirth Survey Form and Instruction UnchangedPRAMS Stillbirth Phone Questionnaire (Spanish)
236591 PRAMS Stillbirth Survey Form and Instruction UnchangedPRAMS Stillbirth Phone Questionnaire (English)
236591 PRAMS Stillbirth Survey Form and Instruction UnchangedPRAMS Stillbirth Mail Questionnaire (Spanish)
236591 PRAMS Stillbirth Survey Form and Instruction UnchangedPRAMS Stillbirth Mail Questionnaire (English)
236591 PRAMS Stillbirth Survey Form and Instruction Unchanged
236590 PRAMS Field Test Form and Instruction UnchangedPRAMS Field Testing Questionnaire (English and Spanish)
236590 PRAMS Field Test Form and Instruction Unchanged
236589 PRAMS Call-back Surveys (with Opioid Call-back Survey Example) Form and Instruction UnchangedPRAMS Opioid Call-back Survey (Spanish)
236589 PRAMS Call-back Surveys (with Opioid Call-back Survey Example) Form and Instruction UnchangedPRAMS Opioid Call-back Survey (English)
236589 PRAMS Call-back Surveys (with Opioid Call-back Survey Example) Form and Instruction Unchanged
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Disabilities Supplement (web mode)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Disabilities Supplement (mail and phone)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Marijuana Use Supplement (web mode)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Marijuana Use Supplement (mail and phone)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Opioid Use Supplement (web mode)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Opioid Use Supplement (mail and phone)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS COVID-19 Experience Supplement (web mode)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS COVID-19 Experience Supplement (mail and phone)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS COVID-19 Vaccine Supplement (web mode)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS COVID-19 Vaccine Supplement (mail and phone)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Social Determinants of Health Supplement (web mode)
236588 PRAMS Supplemental Modules Form and Instruction UnchangedPRAMS Social Determinants of Health Supplement (mail and phone)
236588 PRAMS Supplemental Modules Form and Instruction Unchanged
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Standard Web Module (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Standard Web Module (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Standard Phone Questionnaire (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Standard Phone Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Standard Mail Questionnaire (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Standard Mail Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Standard Phone Module (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Standard Phone Module (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Standard Mail Modules (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Standard Mail Modules (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Core Web Questionnaire (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Core Web Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Core Phone Questionnaire (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Core Phone Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Core Mail Questionnaire (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 9 Core Mail Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Core Phone Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Core Phone Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Core Mail Questionnaire (Spanish)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Livebirth Phase 8 Core Mail Questionnaire (English)
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Phase 8 Web Survey - WY
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Phase 8 Web Survey - VA
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Phase 8 Web Survey - SC
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Phase 8 Web Survey - PR
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction ModifiedPRAMS Phase 8 Web Survey - MD
236587 PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2026 03/31/2026 03/31/2026
108,240 0 108,240
31,268 0 31,268
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
PRAMS Call-back Surveys (with Opioid Call-back Survey Example) n/a, n/a ,  
PRAMS Field Test None
PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) None, None, None, None, None, None, None, None, None, 0920-25-0092, 0920-25-0092, 0920-25-0092, 0920-25-0092, 0920-25-0092, 0920-25-0092, None, None, None, None, 0920-25-0092, 0920-25-0092, 0920-25-0092, 0920-25-0092, 0920-25-0092, 0920-25-0092 ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,  
PRAMS Stillbirth Survey None, None, None, None ,   ,   ,  
PRAMS Supplemental Modules None, None, None, None, None, None, None, None, None, None, None, None ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,  
Submission of Data File to CDC

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 108,240 108,240 0 0 0 0
Annual Time Burden (Hours) 31,268 31,268 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No