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 Application/Annual Report with Needs Assessment Summary	Form and Instruction	Modified	Available
AttachmentCSupportingDocuments Appendix_FY 2019_20121.MCH Block Grant Guidance.Oct_18_2017.docx	Supplementary Document	Uploaded 2017-11-16	Available
Attachment A.FRNs.Nov_7_2017.docx	Supplementary Document	Uploaded 2017-11-16	Available
Final OMB FY 2018 Supporting Statement.MCH Block Grant Guidance.doc	Supporting Statement A	Uploaded 2017-12-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6398	Application/Annual Report with Needs Assessment Summary	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 201711-0915-001
Status: Active	Previous ICR Reference No: 201704-0915-006
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 with change	Conclusion Date: 12/20/2017
	Date Received in OIRA: 11/16/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	36 Months From Approved	12/31/2017
Responses	59	0	59
Time Burden (Hours)	8,437	0	9,160
Cost Burden (Dollars)	0	0	0

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Abstract: This submission is a request for Office of Management and Budget (OMB) approval of the revised Application/Annual Report Guidance that will be used by the 50 States and nine jurisdictions eligible for State formula grants under the MCH Services Block Grant, authorized by Section 501 of Title V of the Social Security Act, PL 101-239. The expiration date for the current Guidance (OMB No. 0915-0172) is December 31, 2017. This revised edition contains two documents: 1)Title V Maternal and Child Health Services Block Grant to States Program Guidance and Forms, which provide instructions to the States on completing the required Application/Annual Report and Reporting Forms; and 2) Appendix of Supporting Documents, which includes background program information and other technical resources. The Application and Annual Report fulfill the requirements of Section 505 and Section 506, respectively, of the Title V legislation.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 26810	06/09/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 52312	11/13/2017
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application/Annual Report with Needs Assessment Summary	2 , 1	Parts 1 & 2 Proposed Updated FY 2019_2021 MCH Block Grant Guidance ,   Part 3 Proposed Updated FY 2019_2021 MCH Block Grant Guidance Forms

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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)	8,437	9,160	0	-723	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: Using Information Technology

Short Statement: Burden was reduced due to these reasons: • Improved alignment of NPMs and SPMs with a state’s identified MCH priority needs • Elimination of one required reporting domain (i.e., Cross-Cutting/Life Course Domain): • Streamlined narrative reporting; • Clearer instructions for completing reporting forms; and • Continued enhancements to the TVIS.

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Annual Cost to Federal Government: $1,155,950

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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Common Form ICR:  No

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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: 11/16/2017

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