APPLICATION AND ANNUAL REPORT, MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
110403	APPLICATION AND ANNUAL REPORT, MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM		Migrated

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 199401-0915-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: APPLICATION AND ANNUAL REPORT, MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/10/1994
	Date Received in OIRA: 01/05/1994
Terms of Clearance: Approved for use through 9/94 under the condition that the next submission for OMB review includes a simplified long and short version of the block grant application guidance and shorter version of the annual report guidance for submissions that the States will make in July 1995. MCH staff will use States' comments as a basis for the new versions and will actively consult state MCH and CSHCN offices, as wel as Governors' Offices in efforts to streamline the application and annual report guidance. This OMB clearance reflects these agreements, as well as clarifications of reporting requirements that are voluntary and state flexibility in selecting form and content for FY 1994 (as articulated in HRSA's "Dear Colleague" letter dated January 4, 1994.) Finally, OMB must receive the next PRA submission no later than 6/94, so that it may reasonably complete its review by 8/94 (as agreed upon with HRSA.)

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1994	09/30/1994
Responses	118	0	0
Time Burden (Hours)	59,625	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THIS IS A REQUEST FOR APPROVAL OF THE COLLECTION OF INFORMATION IN THE GRANT APPLICATION AND ANNUAL REPORTS FOR THE MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM. THE 59 STATES AND JURISDICTIONS PROVIDE THIS INFORMATION TO QUALIFY FOR ALLOTMENT OF FUNDS AUTHORIZED BY SECTION 50 OF THE SOCIAL SECURITY ACT FOR SERVICES FOR PREGNANT WOMEN, MOTHERS, INFANTS, CHILDREN, ADOLESCENTS, AND CHILDREN WITH SPECIAL HEALTH NEEDS

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
APPLICATION AND ANNUAL REPORT, MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	118	0	0	118	0	0
Annual Time Burden (Hours)	59,625	0	0	59,625	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/05/1994

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