Preventive Health and Health Services Block Grant

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attach 7 Pilot Test Participants.doc	Supplementary Document	Uploaded 2008-04-28	Available
Attach 6 Summary of BG-MIS enhancements.docm	Supplementary Document	Uploaded 2008-04-28	Repair queued
Attach 3 List of FY 2008 Awardees.doc	Supplementary Document	Uploaded 2008-04-28	Available
Attach 2 60day FRN 07.26.07.pdf	Supplementary Document	Uploaded 2008-04-28	Available
Attach 1C 45 CFR 96.pdf	Supplementary Document	Uploaded 2008-04-28	Available
Attach 1B PL102-531.pdf	Supplementary Document	Uploaded 2008-04-28	Available
Attach 1A 42 USC 300w 300w8.doc	Supplementary Document	Uploaded 2008-04-28	Available
Attach 5B Annual Report Guidance.doc	Supplementary Document	Uploaded 2008-04-28	Available
Attach 5B Annual Report Guidance.doc	Supplementary Document	Uploaded 2008-04-28	Available
Attach 4B Work Plan Guidance.doc	Supplementary Document	Uploaded 2008-04-29	Available
Supporting Statement A and B.doc	Supporting Statement A	Uploaded 2008-04-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6636	PHHS Block Grant Management Information System (BG-MIS) Work Plan	Other-WORD	Modified
184866	PHHS Block Grant Management Information System (BG-MIS) Annual Report	Other-WORD	New

ICR Details

OMB Control No: 0920-0106	ICR Reference No: 200805-0920-004
Status: Historical Active	Previous ICR Reference No: 200507-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Preventive Health and Health Services Block Grant
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: 08/15/2008
	Date Received in OIRA: 05/12/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2011	36 Months From Approved	10/31/2008
Responses	122	0	122
Time Burden (Hours)	3,355	0	4,270
Cost Burden (Dollars)	0	0	0

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Abstract: This request is a revision of an existing OMB approval for annual grant applications and annual progress reports for the Preventive Health and Health Services Block Grant.

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Authorizing Statute(s): PL: Pub.L. 102 - 531 101-104 Name of Law: Preventive Health and health Services Block Grant
   US Code: 42 USC 300w-300w-8 Name of Law: Preventive Health and Health Services Block Grants
   US Code: 45 USC 96.1-96.17 Name of Law: Block Grants
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 41079	07/26/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 26118	05/08/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
PHHS Block Grant Management Information System (BG-MIS) Work Plan
PHHS Block Grant Management Information System (BG-MIS) Annual Report

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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	122	122	0	0	0	0
Annual Time Burden (Hours)	3,355	4,270	0	-915	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: Miscellaneous Actions

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

Burden Reduction Due to: Using Information Technology

Short Statement: An electronic information collection system (GARS) is currently in use, it is being replaced with a web-based Management Information System (BG-MIS) that will improve standardization of information and decrease burden to respondents.

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Annual Cost to Federal Government: $253,539

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: 05/12/2008

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