Maternal and Child Health Services Block Grant Annual Report and Application Guidance

Forms and Documents

Document Name	Status

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

IC Document Collections

IC ID	Document Title	Status
6395	Maternal and Child Health Services Block Grant Annual Report and Application Guidance	Migrated

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 199709-0915-003
Status: Historical Active	Previous ICR Reference No: 199405-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Services Block Grant Annual Report and Application Guidance
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: 11/26/1997
	Date Received in OIRA: 09/17/1997
Terms of Clearance: This information collection is approved through 11-1999 under the following conditions: As agreed to by the Agency, HRSA will delete from the package, proposed measures 9,12,13 and 15. OMB has agreed to four replacement measures on hearing screening, breastfeeding, suicide and very low birth weights. Upon submission in 1999, HRSA will provide an analysis of the quality of the information and the progress by States in creating and obtaining the data necessary for the reporting. In addition, HRSA will consider modifying some of the output measures to make them more outcome-oriented as States make progress in developing their capacity to influence these health outcomes in these areas. These terms reflect materials received from HRSA on November 24.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/1999	11/30/1999	11/30/1997
Responses	59	0	118
Time Burden (Hours)	31,567	0	33,353
Cost Burden (Dollars)	6,195,000,000	0	0

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Abstract: This is a request for approval of the collection of information in the annual report and grant application 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 title V of the Social Security Act for services for mothers and children.

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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 Services Block Grant Annual Report and Application Guidance

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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	59	118	0	-59	0	0
Annual Time Burden (Hours)	31,567	33,353	0	-1,786	0	0
Annual Cost Burden (Dollars)	6,195,000,000	0	0	6,195,000,000	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: 09/17/1997

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