Maternal and Child Health Services Block Grant Application/Annual Report Guidance

Forms and Documents

Document Name	Status
Form 1 MCHSB Grant Application/Annual Report Guidance Form and Instruction	Modified
State Comments2.pdf Supplementary Document	2014-11-05
State Comments.pdf Supplementary Document	2014-11-05
Public Comments.pdf Supplementary Document	2014-11-05
MCH Pyramid.pdf Supplementary Document	2014-11-05
OMB Supporting Statement.docx Supporting Statement A	2014-11-05

IC Document Collections

IC ID	Document Title	Status
6398	MCHSB Grant Application/Annual Report Guidance Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 201411-0915-001
Status: Historical Active	Previous ICR Reference No: 201111-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Services Block Grant Application/Annual Report Guidance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/23/2014
	Date Received in OIRA: 11/14/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	01/31/2015
Responses	59	0	59
Time Burden (Hours)	9,213	0	14,514
Cost Burden (Dollars)	0	0	0

---

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.

---

Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Social Security Act of 1935
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 36537	06/27/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 67440	11/11/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
MCHSB Grant Application/Annual Report Guidance	1	Guidance and Forms

---

ICR Summary 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)	9,213	14,514	0	-5,301	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The current inventory for this activity in a year in which States do not report on the findings of a Five-year Needs Assessment is 14,514 hours. Given the transformative changes contained in this version of the MCH Block Grant to States Application/Annual Report Guidance, burden to the States is expected to be reduced by 50% (7,257 hours). For a year in which States report on the Five-year Needs Assessment, burden is expected to decrease from 22,332 hours to 11,169 hours. It is recognized that the full extent of the anticipated burden reduction will be realized over time, as States become more familiar with the new instructions and reporting requirements and with the development and implementation of a new electronic Web-based data entry and Web-reports system.

---

Annual Cost to Federal Government: $1,352,957

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

---

Common Form ICR:  No

---

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: 11/14/2014

---