Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
PRAMS Field Test Unchanged 150 50 1227 Form and Instruction n/a PRAMS Field Testing
PRAMS Opioid Call-back Surveys Unchanged 3961 1981 48601 Form and Instruction n/a PRAMS Opioid Call-back Survey (English)
Form and Instruction n/a PRAMS Opioid Call-back Survey (Spanish)
PRAMS Phase 8 Questionnaire (Core Questions plus State-selected Standard Modules) Modified 52070 22564 553712 Form and Instruction n/a PRAMS Livebirth Core Phase 8 Mail Questionnaire (English)
Form and Instruction n/a PRAMS Livebirth Core Phase 8 Mail Questionnaire (Spanish)
Form and Instruction n/a PRAMS Livebirth Core Phase 8 Phone Questionnaire (English)
Form and Instruction n/a PRAMS Livebirth Core Phase 8 Phone Questionnaire (Spanish)
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Mail Modules (English)
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Mail Modules (Spanish)
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Phone Modules (English)
Form and Instruction n/a PRAMS Livebirth Standard Phase 8 Phone Modules (Spanish)
Other-Reference Material: Phase 8 Core and Standard Questions, by Topic Area
Form 0920-1273 Maryland PRAMS Grantee Web Questionnaire
Form 0920-1273 Puerto Rico PRAMS Grantee Web Questionnaire
Form 0920-1273 South Carolina PRAMS Grantee Web Questionnaire
Form 0920-1273 Virginia PRAMS Grantee Web Questionnaire
Form 0920-1273 Wyoming PRAMS Grantee Web Questionnaire
PRAMS Stillbirth Survey Unchanged 160 67 1636 Form and Instruction n/a PRAMS Stillbirth Mail Questionnaire (English)
Form and Instruction n/a PRAMS Stillbirth Mail Questionnaire (Spanish)
Form and Instruction n/a PRAMS Stillbirth Phone Questionnaire (English)
Form and Instruction n/a PRAMS Stillbirth Phone Questionnaire (Spanish)
PRAMS Supplemental Modules Unchanged 61253 5104 125262 Form and Instruction n/a Family History of Breast and Ovarian Cancer Supplement
Form and Instruction n/a Prescription and Illicit Opioid Use Supplement
Form and Instruction n/a Disabilities Supplement
Total burden requested under this ICR: 117594 29766 730438  
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