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Federal forms, ICRs, and supporting documents

Information Collection

PRAMS Supplemental Modules

IC 236588 under ICR 202602-0920-010 · OMB 0920-1273.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
PRAMS Social Determinants of Health Supplement (mail and phone) PRAMS Supplemental Modules Form and Instruction
PRAMS Social Determinants of Health Supplement (web mode) PRAMS Supplemental Modules Form and Instruction
PRAMS COVID-19 Vaccine Supplement (mail and phone) PRAMS Supplemental Modules Form and Instruction
PRAMS COVID-19 Vaccine Supplement (web mode) PRAMS Supplemental Modules Form and Instruction
PRAMS COVID-19 Experience Supplement (mail and phone) PRAMS Supplemental Modules Form and Instruction
PRAMS COVID-19 Experience Supplement (web mode) PRAMS Supplemental Modules Form and Instruction
PRAMS Opioid Use Supplement (mail and phone) PRAMS Supplemental Modules Form and Instruction
PRAMS Opioid Use Supplement (web mode) PRAMS Supplemental Modules Form and Instruction
PRAMS Marijuana Use Supplement (mail and phone) PRAMS Supplemental Modules Form and Instruction
PRAMS Marijuana Use Supplement (web mode) PRAMS Supplemental Modules Form and Instruction
PRAMS Disabilities Supplement (mail and phone) PRAMS Supplemental Modules Form and Instruction
PRAMS Disabilities Supplement (web mode) PRAMS Supplemental Modules Form and Instruction
PRAMS Social Determinants of Health Supplement (mail and
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)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None NA No   Fillable Fileable
Form and Instruction None NA Yes Yes Fillable Fileable
Form and Instruction None N/A No   Fillable Fileable
Form and Instruction None N/A Yes Yes Fillable Fileable
Form and Instruction None N/A No   Fillable Fileable
Form and Instruction None N/A Yes Yes Fillable Fileable
Form and Instruction None NA No   Fillable Fileable
Form and Instruction None NA Yes Yes Fillable Fileable
Form and Instruction None N/A No   Fillable Fileable
Form and Instruction None N/A Yes Yes Fillable Fileable
Form and Instruction None No   Paper Only
Form and Instruction None Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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

Documents for IC
table that charts IC Documents
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.
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