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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 002 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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	002	MCHB Financial and Demographic Forms	Attachment B - Part 2 - Financial and Demographic Forms - no change....pdf		Yes	Yes	Fillable Fileable
Form	003	MCHB Additional Data Elements Form	Attachment C - Part 3 - Additional Data Elements.pdf		Yes	Yes	Fillable Fileable
Form	001	MCHB Discretionary Grant Performance Measures	Attachment A - Part 1 - Performance Measures.pdf	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 %

	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

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.