Information Collection

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

IC 6553 under ICR 200903-0915-004 · OMB 0915-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0298 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 002 MCHB Financial and Demographic Forms Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form
Form 003 MCHB Additional Data Elements Form Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form
Form 001 MCHB Discretionary Grant Performance Measures Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form
002 MCHB Financial and Demographic Forms Attachment B - Part 2 - Financial and Demographic Forms - no change....pdf	Form
003 MCHB Additional Data Elements Form Attachment C - Part 3 - Additional Data Elements.pdf	Form
001 MCHB Discretionary Grant Performance Measures Attachment A - Part 1 - Performance Measures.pdf perfdata.hrsa.gov/MCHB/DGISReports/default.aspx	Form

IC Title:

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	002		Yes	Yes	Fillable Fileable
Form	003		Yes	Yes	Fillable Fileable
Form	001	https://perfdata.hrsa.gov/MCHB/DGISReports/default.aspx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 898

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	898	267	631
Annual IC Time Burden (Hours)	5,388	1,602	3,786
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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