Maternal and Child Health Bureau Performance Measures for Discretionary Grant Information System (DGIS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form C Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form and Instruction	Modified	Available
Final_2016 OMB Request for Non-Substantive Change_DGIS Collection OMB0915-0298.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-11-14	Available
Attachment B-1 - Crosswalk Table.docx	Supplementary Document	Uploaded 2016-03-22	Available
ATTACH A Social Security Act §501.mht	Supplementary Document	Uploaded 2016-03-22	Repair queued
FINALMCHB DGIS Supporting Statement 2015_JM Changes.doc	Supporting Statement A	Uploaded 2016-03-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6553	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0298	ICR Reference No: 201611-0915-003
Status: Historical Active	Previous ICR Reference No: 201603-0915-004
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Bureau Performance Measures for Discretionary Grant Information System (DGIS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/28/2016
	Date Received in OIRA: 11/15/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2019	06/30/2019	06/30/2019
Responses	600	0	600
Time Burden (Hours)	21,600	0	21,600
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a request by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) for Office of Management and Budget (OMB) approval to revise the collection of information from public and private agencies or organizations engaged in demonstrations, research, training, or other projects that receive funding from the Special Projects of Regional and National Significance (SPRANS) and Community Integrated Service Systems (CISS) federal discretionary grant programs, and other categorical discretionary grant programs.

---

Authorizing Statute(s): PL: Pub.L. 97 - 35 XXI Name of Law: Title XXI: Medicare, Medicaid, and Maternal and Child Health, Omnibus Budget Reconciliation
   PL: Pub.L. 101 - 239 501 Name of Law: Social Security Act
   US Code: 42 USC 509 Name of Law: Title V: Maternal and Child Block Health Services Block Grant, Social Security Act
  

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:
	80 FR 215	11/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 50	03/15/2016
Did the Agency receive public comments on this ICR? No

---

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 Bureau Performance Measures for Discretionary Grants	D, B, C	Attachment C Forms ,   Final_ Change Memo_Attachment B - Detail Sheets.docx ,   Final_ Change Memo_Attachment D - Additional Data Elements.docx

---

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	600	600	0	0	0	0
Annual Time Burden (Hours)	21,600	21,600	0	0	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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $782,000

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: 11/15/2016

---