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) Unchanged 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 Modified 92753 8979 220344 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
Form and Instruction 0920-1273 PRAMS Social Determinants of Health (SDOH) Supplemental Module
Form and Instruction n/a PRAMS COVID-19 Experience Supplemental Module (English or Spanish, mail or phone)
Form and Instruction n/a PRAMS COVID-19 Experience Supplemental Module (screenshots of web mode)
Form and Instruction n/a PRAMS COVID-19 Vaccine Supplemental Module (English or Spanish, mail or phone)
Form and Instruction n/a PRAMS COVID-19 Vaccine Supplemental Module (screenshots of web mode)
Total burden requested under this ICR: 149094 33641 825520  
To view an IC, click on IC Title