Forms for Use with Applications to the Maternal and Child Health Bureau Research and Training Grants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 PHS_Inclusion-Enrollment-Form.pdf	Form and Instruction	New	Available
Form 1 Biographical Sketch for Research Grant Applicants-PI-race-ethnicity-data	Form and Instruction	New	Available
FINAL Supporting Statement A_201909-0906-003_CLEAN_DOR_12.19.19.docx	Supporting Statement A	Uploaded 2020-01-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
237700	PHS Inclusion Enrollment Form for MCHB Research and Training Grant Applications	Form and Instruction	New	PHS_Inclusion-Enrollment-Form.pdf
237698	Biographical Sketch for MCHB Research and Training Grant Applicants	Form and Instruction	New	Biographical Sketch for Research Grant Applicants-PI-race-ethnicity-data

ICR Details

OMB Control No: 0906-0048	ICR Reference No: 201909-0906-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Forms for Use with Applications to the Maternal and Child Health Bureau Research and Training Grants
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/08/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/10/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved
Responses	1,200	0	0
Time Burden (Hours)	2,100	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA proposes to collect information in that describes the qualifications of proposed researchers and the description of research participants. This is an important component of ensuring demographic diversity (race, ethnicity, and gender) among research study participants. This allows MCHB to determine to what extent individuals of different backgrounds are participating. Likely respondents are potential applicants to HRSA’s MCHB research and training programs.

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Authorizing Statute(s): PL: Pub.L. 0 - 0 3506 (c)(2)(A) Name of Law: Paperwork Reduction Act of 1995
   PL: Pub.L. 97 - 35 0 Name of Law: OBRA 1981
   PL: Pub.L. 101 - 239 501(a)(2) and (3) Name of Law: OBRA 1989
  

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:
	83 FR 46504	09/13/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 45502	08/29/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Biographical Sketch for MCHB Research and Training Grant Applicants	1	Biographical Sketch for Research Grant Applicants-PI-race-ethnicity-data
PHS Inclusion Enrollment Form for MCHB Research and Training Grant Applications	2	PHS_Inclusion-Enrollment-Form.pdf

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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	1,200	0	0	1,200	0	0
Annual Time Burden (Hours)	2,100	0	0	2,100	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR so this is an increase in burden from zero (0).

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Annual Cost to Federal Government: $6,899

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: 09/10/2019

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