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 D Attachment D - Additional Data Elements.docx	Form and Instruction	Unchanged	Available
Form C Attachment C - Financial and Demographic Data Elements.docx	Form and Instruction	Unchanged	Available
Form B Attachment B - Measures and Detail Sheets.docx	Form and Instruction	Unchanged	Available
18c_MCH Survey_FSM_Pohnpeian.doc	Supplementary Document	Uploaded 2019-09-26	Available
18b_MCH Jurisdictional Survey Leave-Behind Consent_Pohnpeian.docx	Supplementary Document	Uploaded 2019-09-26	Repair queued
18a_MCH Jurisdictional Survey Eligibility and Consent Script_Pohnpeian.docx	Supplementary Document	Uploaded 2019-09-26	Available
17c_MCH Survey_RMI_Marshallese Aug 2019.doc	Supplementary Document	Uploaded 2019-09-26	Available
17b_MCH Jurisdictional Survey Leave-Behind Consent_Marshallese.docx	Supplementary Document	Uploaded 2019-09-26	Available
17a_MCH Jurisdictional Survey Eligibility and Consent Script_Marshallese.docx	Supplementary Document	Uploaded 2019-09-26	Repair queued
16_Updated MCH Survey_USVI_Spanish.doc	Supplementary Document	Uploaded 2019-09-26	Available
15_Updated MCH Survey_PR_Spanish.doc	Supplementary Document	Uploaded 2019-09-26	Available
14_Updated MCH Survey_Palau_Tagalog.doc	Supplementary Document	Uploaded 2019-09-26	Available
13_Updated MCH Survey_Palau_Palauan.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
12_Updated MCH Survey_Guam_Tagalog.doc	Supplementary Document	Uploaded 2019-09-26	Available
11_Updated MCH Survey_Guam_Chuukese.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
10_Updated MCH Survey_FSM_Chuukese.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
09_Updated MCH Survey_American Samoa_Samoan.doc	Supplementary Document	Uploaded 2019-09-26	Available
08_Updated MCH Survey_USVI_English.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
07_Updated MCH Survey_PR_English.doc	Supplementary Document	Uploaded 2019-09-26	Available
06_Updated MCH Survey_Palau_English.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
05_Updated MCH Survey_CNMI_English.doc	Supplementary Document	Uploaded 2019-09-26	Available
04_Updated MCH Survey_RMI_English.doc	Supplementary Document	Uploaded 2019-09-26	Available
03_Updated MCH Survey_Guam_English.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
02_Updated MCH Survey_FSM_English.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
01_Updated MCH Survey_AS_English.doc	Supplementary Document	Uploaded 2019-09-26	Repair queued
Jurisdictional Survey OMB Request for Non-Substantive ChangeLWS_OMB_9.24.2019_FINAL.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-09-26	Repair queued
Attachment A - Legislation.pdf	Supplementary Document	Uploaded 2019-05-20	Available
MCHB DGIS Supporting Statement 2019.doc	Supporting Statement A	Uploaded 2019-05-20	Repair queued

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	Unchanged	Attachment D - Additional Data Elements.docx
6553	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form and Instruction	Unchanged	Attachment C - Financial and Demographic Data Elements.docx
6553	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form and Instruction	Unchanged	Attachment B - Measures and Detail Sheets.docx
6553	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Other-Tracked Changes	Unchanged

ICR Details

OMB Control No: 0915-0298	ICR Reference No: 201909-0915-005
Status: Historical Inactive	Previous ICR Reference No: 201905-0915-002
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: Improperly submitted and continue	Conclusion Date: 11/05/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/27/2019
Terms of Clearance: Per the request of HHS/HRSA on 10/28/2019, This ICR is being returned as improperly submitted.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	06/30/2022	06/30/2022
Responses	700	0	700
Time Burden (Hours)	25,200	0	25,200
Cost Burden (Dollars)	0	0	0

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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.

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Authorizing Statute(s): PL: Pub.L. 103 - 62 0 Name of Law: Govt. Perf. and Results Act of 1993
   US Code: 42 USC 701-710 Name of Law: Title V: Maternal and Child Block Health Services Block Grant, Social Security Act
   PL: Pub.L. 111 - 352 0 Name of Law: Govt. Perf. and Results Modernization Act of 2010
  

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 56353	11/13/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 23796	05/23/2019
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
Maternal and Child Health Bureau Performance Measures for Discretionary Grants	D, C, B	Attachment B - Measures and Detail Sheets.docx ,   Attachment C - Financial and Demographic Data Elements.docx ,   Attachment D - Additional Data Elements.docx

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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: The burden increase is due to an increase in the number of programs expected to be reporting (respondents).

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Annual Cost to Federal Government: $891,000

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: 09/27/2019

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