PRA IC List
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Agenda
Reg Review
ICR
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)
Removed
0
0
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
Removed
0
0
0
Form and Instruction
None
PRAMS Field Testing Questionnaire (English and Spanish)
PRAMS Phase 9 Questionnaires (Core Questions plus Jurisdiction-selected Standard Modules)
Modified
51556
22341
0
Form and Instruction
0920-1273
Phase 9 Core Mail Questionnaire – English
Form and Instruction
0920-1273
Phase 9 Core Mail Questionnaire – Spanish
Form and Instruction
0920-1273
Phase 9 Core Phone Questionnaire – English
Form and Instruction
0920-1273
Phase 9 Core Phone Questionnaire – Spanish
Form and Instruction
0920-1273
Phase 9 Core Web Questionnaire – English
Form and Instruction
0920-1273
Phase 9 Core Web Questionnaire – Spanish
Form and Instruction
0920-1273
Phase 9 Standard Mail Questionnaire – English
Form and Instruction
0920-1273
Phase 9 Standard Mail Questionnaire – Spanish
Form and Instruction
0920-1273
Phase 9 Standard Phone Questionnaire – English
Form and Instruction
0920-1273
Phase 9 Standard Phone Questionnaire – Spanish
Form and Instruction
0920-1273
Phase 9 Standard Web Module – English
Form and Instruction
0920-1273
Phase 9 Standard Web Module – Spanish
PRAMS Stillbirth Questionnaire
Modified
160
67
0
Form and Instruction
0920-1273
PRAMS Stillbirth Mail Questionnaire (English)
Form and Instruction
0920-1273
PRAMS Stillbirth Mail Questionnaire (Spanish)
Form and Instruction
0920-1273
PRAMS Stillbirth Phone Questionnaire (English)
Form and Instruction
0920-1273
PRAMS Stillbirth Phone Questionnaire (Spanish)
PRAMS Supplemental Modules
Modified
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:
105300
29773
0
To view an IC, click on IC Title
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