Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
PRAMS Call-back Surveys (with Opioid Call-back Survey Example) Unchanged 2790 1395 0 Form and Instruction n/a PRAMS Opioid Call-back Survey (English)
Form and Instruction n/a PRAMS Opioid Call-back Survey (Spanish)
PRAMS Field Test Unchanged 150 100 0 Form and Instruction None PRAMS Field Testing Questionnaire (English and Spanish)
PRAMS Phase 8 and Phase 9 Questionnaires (Core Questions plus State-selected Standard Modules) Unchanged 51556 22341 0 Form and Instruction None PRAMS Phase 8 Web Survey - MD
Form and Instruction None PRAMS Phase 8 Web Survey - PR
Form and Instruction None PRAMS Phase 8 Web Survey - SC
Form and Instruction None PRAMS Phase 8 Web Survey - VA
Form and Instruction None PRAMS Phase 8 Web Survey - WY
Form and Instruction None PRAMS Livebirth Phase 8 Core Mail Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 8 Core Mail Questionnaire (Spanish)
Form and Instruction None PRAMS Livebirth Phase 8 Core Phone Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 8 Core Phone Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 9 Core Mail Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 9 Core Mail Questionnaire (Spanish)
Form and Instruction None PRAMS Livebirth Phase 9 Core Phone Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 9 Core Phone Questionnaire (Spanish)
Form and Instruction None PRAMS Livebirth Phase 9 Core Web Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 9 Core Web Questionnaire (Spanish)
Form and Instruction None PRAMS Livebirth Phase 8 Standard Mail Modules (English)
Form and Instruction None PRAMS Livebirth Phase 8 Standard Mail Modules (Spanish)
Form and Instruction None PRAMS Livebirth Phase 8 Standard Phone Module (English)
Form and Instruction None PRAMS Livebirth Phase 8 Standard Phone Module (Spanish)
Form and Instruction None PRAMS Livebirth Phase 9 Standard Mail Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 9 Standard Mail Questionnaire (Spanish)
Form and Instruction None PRAMS Livebirth Phase 9 Standard Phone Questionnaire (English)
Form and Instruction None PRAMS Livebirth Phase 9 Standard Phone Questionnaire (Spanish)
Form and Instruction None PRAMS Livebirth Phase 9 Standard Web Module (English)
Form and Instruction None PRAMS Livebirth Phase 9 Standard Web Module (Spanish)
PRAMS Stillbirth Survey Unchanged 160 67 0 Form and Instruction None PRAMS Stillbirth Mail Questionnaire (English)
Form and Instruction None PRAMS Stillbirth Mail Questionnaire (Spanish)
Form and Instruction None PRAMS Stillbirth Phone Questionnaire (English)
Form and Instruction None PRAMS Stillbirth Phone Questionnaire (Spanish)
PRAMS Supplemental Modules Unchanged 52984 7065 0 Form and Instruction None PRAMS Social Determinants of Health Supplement (mail and phone)
Form and Instruction None PRAMS Social Determinants of Health Supplement (web mode)
Form and Instruction None PRAMS COVID-19 Vaccine Supplement (mail and phone)
Form and Instruction None PRAMS COVID-19 Vaccine Supplement (web mode)
Form and Instruction None PRAMS COVID-19 Experience Supplement (mail and phone)
Form and Instruction None PRAMS COVID-19 Experience Supplement (web mode)
Form and Instruction None PRAMS Opioid Use Supplement (mail and phone)
Form and Instruction None PRAMS Opioid Use Supplement (web mode)
Form and Instruction None PRAMS Marijuana Use Supplement (mail and phone)
Form and Instruction None PRAMS Marijuana Use Supplement (web mode)
Form and Instruction None PRAMS Disabilities Supplement (mail and phone)
Form and Instruction None PRAMS Disabilities Supplement (web mode)
Submission of Data File to CDC Unchanged 600 300 0 Instruction
Total burden requested under this ICR: 108240 31268 0  
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