Maternal and Child Health Services Block Grant Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form mchb block grant g Maternal and Child Health Services Block Grant Report	Form and Instruction	Modified	Available
OMB Passback.doc	Supplementary Document	Uploaded 2009-03-04	Available
Changes to MCH Block Grant Guidance 2008.pdf	Supplementary Document	Uploaded 2008-12-08	Available
State Title V MCH and CSHCN Directors.pdf	Supplementary Document	Uploaded 2008-12-08	Available
Title V workgroup.pdf	Supplementary Document	Uploaded 2008-12-08	Available
TITLE_V_OF_THE_SOCIAL_SECURITY_ACT.pdf	Supplementary Document	Uploaded 2008-12-08	Available
THE MCH PYRAMID.pdf	Supplementary Document	Uploaded 2008-12-08	Available
ss 0915-0172 2008.pdf	Supporting Statement A	Uploaded 2008-12-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6398	Maternal and Child Health Services Block Grant Report	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 200812-0915-001
Status: Historical Active	Previous ICR Reference No: 200602-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Services Block Grant 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: 03/10/2009
	Date Received in OIRA: 12/17/2008
Terms of Clearance: This ICR is approved consistent with HRSA passback memo of 3/4/09. Previous terms of clearance remain in effect.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2012	36 Months From Approved	05/31/2009
Responses	59	0	59
Time Burden (Hours)	18,064	0	18,064
Cost Burden (Dollars)	0	0	0

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Abstract: The MCH Block Grant is a formula grant under which funds are awarded to all 59 States and jurisdictions upon their submission of an acceptable plan to meet the health services needs of the target populations of mothers, infants, children, and children with special health care needs. The data collected from grantees are necessary to manage and monitor the use of grant funds.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Social Security Act of 1935
  

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:
	73 FR 56596	09/29/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 73336	12/02/2008
Did the Agency receive public comments on this ICR? Yes

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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
Maternal and Child Health Services Block Grant Report	mchb block grant guidance -2009	MCHB Block Grant Guidance

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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	59	59	0	0	0	0
Annual Time Burden (Hours)	18,064	18,064	0	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $812,000

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: 12/17/2008

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