Information Collection

Maternal and Child Health Services Block Grant Report

IC 6398 under ICR 201111-0915-003 · OMB 0915-0172.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0172 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Maternal and Child Health Services Block Grant Report Form and Instruction
1 MCHB Block Grant Guidance for Application/Annual Report FINAL Application_Report AttachCGuidance_10-31-11 (2).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Maternal and Child Health Services Block Grant Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	MCHB Block Grant Guidance for Application/Annual Report	FINAL Application_Report AttachCGuidance_10-31-11 (2).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	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	59	0	59
Annual IC Time Burden (Hours)	14,514	-3,550	18,064
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.