Information Collection

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

IC 6553 under ICR 202001-0915-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 C 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_CLEAN REVISED.do Attachment D - Additional Data Elements_CLEAN REVISED.docx	Form and Instruction
FINALMCHB DGIS Non Substantitive Changes Memo 0915-0298_0120.docx Change Memo	IC Document

IC Title:

Maternal and Child Health Bureau Performance Measures for Discretionary Grants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	C	Attachment C - Financial and Demographic Data Elements.docx	Attachment C - Financial and Demographic 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	Yes	Yes	Printable Only
Form and Instruction	D	Attachment D - Additional Data Elements_CLEAN REVISED.docx	Attachment D - Additional Data Elements_CLEAN REVISED.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B	Attachment B - Measures and Detail Sheets.docx	Attachment B - Measures and Detail Sheets.docx	Yes	Yes	Fillable Fileable

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
	Approved	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
Change Memo	FINALMCHB DGIS Non Substantitive Changes Memo 0915-0298_0120.docx	01/23/2020

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