Maternal and Child Health Bureau Performance Measures for Discretionary Grants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 001 MCHB Discretionary Grant Performance Measures	Form	Modified	Available
Form 003 MCHB Additional Data Elements Form	Form	Modified	Available
Form 002 MCHB Financial and Demographic Forms	Form	Modified	Available
ICRMaternalChildHealthLetter_HRSA_Memo.pdf	Supplementary Document	Uploaded 2009-10-27	Available
ICRMaternalChildHealthLetter_HRSA_Response_09-09.pdf	Supplementary Document	Uploaded 2009-10-27	Available
Attachment F - Expert Panel List.pdf	Supplementary Document	Uploaded 2009-03-25	Available
Attachment D - THE MCH PYRAMID.pdf	Supplementary Document	Uploaded 2009-03-25	Available
Attachment B - Part 2 - Financial and Demographic Forms - no change....pdf	Supplementary Document	Uploaded 2009-03-25	Repair queued
Attachment B - Part 2 - Financial and Demographic Forms - with changes.pdf	Supplementary Document	Uploaded 2009-03-25	Available
ss_0298 DGIS.pdf	Supporting Statement A	Uploaded 2009-03-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6553	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form	Modified	MCHB Discretionary Grant Performance Measures
6553	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form	Modified	MCHB Additional Data Elements Form
6553	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form	Modified	MCHB Financial and Demographic Forms

ICR Details

OMB Control No: 0915-0298	ICR Reference No: 200903-0915-004
Status: Historical Active	Previous ICR Reference No: 200601-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Bureau Performance Measures for Discretionary Grants
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/29/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/30/2009
Terms of Clearance: This ICR is approved consistent with the terms of the memo of October 21, 2009, which states “As a condition of approval of this ICR, HRSA has agreed that in order to reassess the burden to grantees for the HRSA/MCHB Discretionary Grant measures, HRSA will conduct a pilot study to obtain current burden estimates. If those estimates greatly deviate from the current estimate of 6 hours, HRSA will submit a change request to OMB.”

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	36 Months From Approved	10/31/2009
Responses	898	0	631
Time Burden (Hours)	5,388	0	3,786
Cost Burden (Dollars)	0	0	0

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Abstract: This consolidated set of performance measures collects information from public or private agencies or organizations engaged in demonstrations, research, training, or other projects that receive funding from the Special Projects of Regional and National Significane (SPRANS) and Community Integrated Service Systems (CISS) federal and discretionary grant programs, and other categorical discretionary grant programs.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Social Security Act
   US Code: 42 USC 509 Name of Law: Title V: Maternal and Child Block Health Services Block Grant, Social Security Act
   PL: Pub.L. 97 - 35 XXI Name of Law: Title XXI: Medicare, Medicaid, and Maternal and Child Health, Omnibus Budget Reconciliation
  

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 73335	12/02/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 14137	03/30/2009
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 Bureau Performance Measures for Discretionary Grants	002, 003, 001	MCHB Financial and Demographic Forms ,   MCHB Additional Data Elements Form ,   MCHB Discretionary Grant Performance Measures

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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	898	631	0	0	267	0
Annual Time Burden (Hours)	5,388	3,786	0	0	1,602	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: $755,000

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)? No

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: 03/30/2009

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