Information Collection

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

IC 6553 under ICR 201210-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1 Maternal and Child Health Bureau Performance Measures for Discretionary Grants Form and Instruction
1 Detail Sheets Attach B - Detail Sheets.doc Form and Instruction
2 Demographic Forms Attach C -REV Fin and Demo Forms.doc Form and Instruction
3 ADE Attach D - ADE.docx Form and Instruction
ATTACH F OMBDGISBurdenReassess.docx Burden Reassessment IC Document
ATTACH A Social Security Act 501.mht Social Security Act IC Document
Attachment E - THE MCH PYRAMID.pdf MCH Pyramid IC Document

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Detail Sheets	Attach B - Detail Sheets.doc	Yes	Yes	Fillable Fileable
Form and Instruction	2	Demographic Forms	Attach C -REV Fin and Demo Forms.doc	Yes	Yes	Fillable Fileable
Form and Instruction	3	ADE	Attach D - ADE.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	900	0	2	898
Annual IC Time Burden (Hours)	37,062	162	31,512	5,388
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Reassessment	ATTACH F OMBDGISBurdenReassess.docx	10/09/2012
Social Security Act	ATTACH A Social Security Act 501.mht	10/09/2012
MCH Pyramid	Attachment E - THE MCH PYRAMID.pdf	10/09/2012

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