Information Collection

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

IC 6553 under ICR 201603-0915-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form B Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form and Instruction
B Detail Sheets Attachment B - Detail Sheets.docx	Form and Instruction
D Additional Data Elements Attachment D - Additional Data Elements.docx	Form and Instruction
C Attachment C Forms Attachment C_Forms.docx	Form and Instruction
ATTACH A Social Security Act §501.mht SS Act	IC Document
Attachment B-1 - Crosswalk Table.docx Crosswalk Performance Measures	IC Document
Attachment E - Public Comments.pdf Public Comments	IC Document
Attachment F Summary of Public Comments.xlsx Summary of Public Comments	IC Document

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	B	Detail Sheets	Attachment B - Detail Sheets.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D	Additional Data Elements	Attachment D - Additional Data Elements.docx	Yes	Yes	Fillable Fileable
Form and Instruction	C	Attachment C Forms	Attachment C_Forms.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	600	-300	900
Annual IC Time Burden (Hours)	21,600	-15,462	37,062
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS Act	ATTACH A Social Security Act Â§501.mht	03/22/2016
Crosswalk Performance Measures	Attachment B-1 - Crosswalk Table.docx	03/22/2016
Public Comments	Attachment E - Public Comments.pdf	03/22/2016
Summary of Public Comments	Attachment F Summary of Public Comments.xlsx	03/22/2016

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