Information Collection

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

IC 6553 under ICR 201909-0915-005 · OMB 0915-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0298 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form B Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Form and Instruction
Attachment C - Financial and Demographic Data Elements_track change.docx	Other-Tracked Changes
Attachment D - Additional Data Elements_track change.docx	Other-Tracked Changes
B Attachment B - Measures and Detail Sheets.docx Attachment B - Measures and Detail Sheets.docx	Form and Instruction
C Attachment C - Financial and Demographic Data Elements.d Attachment C - Financial and Demographic Data Elements.docx	Form and Instruction
D Attachment D - Additional Data Elements.docx Attachment D - Additional Data Elements.docx	Form and Instruction

IC Title:

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	B	Attachment B - Measures and Detail Sheets.docx	Attachment B - Measures and Detail Sheets.docx	Yes	Yes	Fillable Fileable
Form and Instruction	C	Attachment C - Financial and Demographic Data Elements.docx	Attachment C - Financial and Demographic Data Elements.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D	Attachment D - Additional Data Elements.docx	Attachment D - Additional Data Elements.docx	Yes	Yes	Fillable Fileable
Other-Tracked Changes			Attachment C - Financial and Demographic Data Elements_track change.docx	No		Printable Only
Other-Tracked Changes			Attachment D - Additional Data Elements_track change.docx	No		Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	25,200	25,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.