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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Guidance and Forms	Form and Instruction	Modified	Available
OMB Supporting Statement.docx	Supporting Statement A	Uploaded 2017-04-17	Available
OMB Approved.MCH Block Grant Guidance.Title and TOC.Jan_2015_REVISED.docx	Supplementary Document	Uploaded 2017-04-14	Available
(1)Updated OMB Change Request.MCH Block Grant Guidance Main Sections.April_14_2017.docx	Supplementary Document	Uploaded 2017-04-14	Available
(1) Updated OMB Change Request.Appendix.MCHBG to States Guidance.April_11_2017 Nora.docx	Supplementary Document	Uploaded 2017-04-14	Available
(1) Title V.OMB Request for Non-Substantive Change_OMB0915-0172.04_11_2017 CC.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-04-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6398	MCHSB Grant Application/Annual Report Guidance	Form and Instruction	Modified	Guidance and Forms

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 201704-0915-006
Status: Historical Active	Previous ICR Reference No: 201411-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Services Block Grant Application/Annual Report Guidance
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 with change	Conclusion Date: 04/18/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/17/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	12/31/2017	12/31/2017
Responses	59	0	59
Time Burden (Hours)	9,160	0	9,213
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

table that charts list of burden

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

---

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	59	59	0	0	0	0
Annual Time Burden (Hours)	9,160	9,213	0	-53	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: Changing Regulations

Short Statement: It is anticipated that the revisions included in the change memo will reduce reporting burden for State Title V programs.

---

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: 04/17/2017

---