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

Forms and Documents

Document	Type	Status	Availability

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

IC Document Collections

IC ID	Collection	Type	Status	Form
110404	MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM: APPLICATION AND ANNUAL REPORT		Migrated

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 199405-0915-002
Status: Historical Active	Previous ICR Reference No: 199401-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM: APPLICATION AND ANNUAL REPORT
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/23/1994
	Date Received in OIRA: 05/25/1994
Terms of Clearance: This revised OMB submission and its amendments dated 6/29/94 and 8/22/94 are approved for use through 8/97 under the following conditions: 1) HHS includes in its next Federal Register publicatio of the Regulatory Agenda an entry committing to the promulgation of a rulemaking that would amend existing regulations so they are consisten with statutory provisions mandating the standardized form and content the MCH Block Grant application and annual report. This entry should include a projected date for publishing this rulemaking; and 2) HRSA continues to consult with the state MCH and CSHCN offices, as well as the Governors' Offices, in evaluating and refining the new application and annual report. In particular, HRSA should continue to evaluate th practical utility and burden imposed by the mandatory and optional data cells contained in Forms 2AR - 8AR of the Annual Report. In addition, OMB approves HRSA's request to pursue solutions to four unresolved data issues (Tab E of OMB submission.) OMB will consider HRSA's request to pilot each of these projects on a case-by-case basis depending on its assessment of HRSA's Progress Report for each project (Attachment 1). It would be useful for HRSA to update its timetable for developing these forms and to submit this revised timetable fo public docket.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/1997	08/31/1997	09/30/1994
Responses	118	0	118
Time Burden (Hours)	33,353	0	59,625
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

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

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ICR Summary 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	118	0	0	0	0
Annual Time Burden (Hours)	33,353	59,625	0	-30,022	3,750	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

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: 05/25/1994

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