View Information Collection (IC)

View Information Collection (IC)

IC Title:	PRAMS - English	Agency IC Tracking Number:	16GL

IC Status: New

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	none	PRAMS Phase 8 Supplemental Questions	PRAMS P8 App1a 120415.docx		Yes	No	Fillable Fileable
Form	none	PRAMS screener	PRAMS P8 App3 Telephone Screener rev.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: Health and Demographic Surveys Conducted in Probability Samples o fhte US Population	FR Citation: 49 FR 37693

Number of Respondents: 68	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	68	0	68	0	0	0
Annual IC Time Burden (Hours)	34	0	34	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
10 day Letter to Dr. Schwab	0920-0222 10-day letter PRAMS English 120415.docx	12/07/2015
Questions and Rationale for Selection	PRAMS P8 App1b 120415.docx	12/07/2015
Flyers and Advertisements	PRAMS P8 App2 ad&flyers.docx	12/07/2015
Consent	PRAMS P8 App4 Informed Consent.docx	12/07/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.