Maternal and Child Health Services Block Grant Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Maternal and Child Health Services Block Grant Report	Form and Instruction	Modified	Available
Screenshots Justification 2011.doc	Supplementary Document	Uploaded 2011-11-08	Available
ATTACH H NGA letter.pdf	Supplementary Document	Uploaded 2011-11-08	Available
ATTACHGMCH State Contacts.pdf	Supplementary Document	Uploaded 2011-11-08	Available
ATTACHFTitle V Block Grant Revisio Work Group.docx	Supplementary Document	Uploaded 2011-11-08	Available
ATTACHDTHE MCH PYRAMID1.pdf	Supplementary Document	Uploaded 2011-11-08	Available
ATTACHBChanges to MCH Block Grant Guidance FY12.docx	Supplementary Document	Uploaded 2011-11-08	Available
Nov3FINAL Fy12 Supporting Statement.doc	Supporting Statement A	Uploaded 2011-11-08	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: 201111-0915-003
Status: Historical Active	Previous ICR Reference No: 200812-0915-001
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 with change	Conclusion Date: 01/20/2012
	Date Received in OIRA: 11/10/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	03/31/2012
Responses	59	0	59
Time Burden (Hours)	14,514	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:
	76 FR 42717	07/19/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 67198	10/31/2011
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	1	MCHB Block Grant Guidance for Application/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	59	59	0	0	0	0
Annual Time Burden (Hours)	14,514	18,064	0	0	-3,550	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: $795,904

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 11/10/2011

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