Preventive Health and Health Services Block Grant

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Work Plan Instrument	Form and Instruction	Modified	Repair queued
Recipient Information	Form and Instruction	New	Repair queued
Annual Progress Report Instrument	Form and Instruction	Modified	Repair queued
Att H_Communications Notifications Log.docx	Supplementary Document	Uploaded 2020-09-08	Repair queued
60 day FRN.pdf	Supplementary Document	Uploaded 2020-09-08	Repair queued
Att C_Block Grant Authorizing Legislation 1981 and 1992.docx	Supplementary Document	Uploaded 2020-09-08	Repair queued
Att B_List of PHHS Block Grant Recipients.docx	Supplementary Document	Uploaded 2020-09-08	Repair queued
Att A_Summary of Changes Between BGMIS and BGIS Data Collection Instruments.docx	Supplementary Document	Uploaded 2020-09-08	Repair queued
Statement B-Block Grant ICR_2020_4-22_082720.docx	Supporting Statement B	Uploaded 2020-09-08	Available
Statement A-Block Grant ICR_2020_083120.docx	Supporting Statement A	Uploaded 2020-09-08	Repair queued
Att C_PL102-531[1].pdf	Supplementary Document	Uploaded 2019-06-27	Repair queued
Att B_42_USC_300w.doc	Supplementary Document	Uploaded 2019-06-27	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6636	Work Plan Instrument	Form and Instruction	Modified
243520	Recipient Information	Form and Instruction	New
184866	Annual Progress Report Instrument	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0106	ICR Reference No: 202009-0920-006
Status: Received in OIRA	Previous ICR Reference No: 201906-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0106
Title: Preventive Health and Health Services Block Grant
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/14/2020

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2022
Responses	183	122
Time Burden (Hours)	1,525	2,135
Cost Burden (Dollars)	487,678	0

---

Abstract: The purpose of this colledtion is to ensure that the CDC PHHS Block Grant program managers and PHHS Block Grant recipients account for funds in accordance with legislative mandates by providing information on work through work plans and annual reports. CDC will use the Block Grant Information System to monitor awardees' progress, identify activities and personnel supported with Block Grant funding, and conduct compliance reviews of Block Grant awardees.

---

Authorizing Statute(s): US Code: 45 USC 96.1-96.17 Name of Law: Block Grants
   PL: Pub.L. 102 - 531 101-104 Name of Law: Preventive Health and health Services Block Grant
   US Code: 42 USC 300w-300w-8 Name of Law: Preventive Health and Health Services Block Grants
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 30963	05/21/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 56620	09/14/2020
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Work Plan Instrument	none	Work plan instruments
Annual Progress Report Instrument	none	Annual Progress Report Instruments
Recipient Information	none	Recipient Information Instruments

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	183	122	0	61	0	0
Annual Time Burden (Hours)	1,525	2,135	0	-610	0	0
Annual Cost Burden (Dollars)	487,678	0	0	487,678	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: An additional instrument has been added, although changes to the existing instruments have resulted in a reduction in burden. Changing from narrative responses to multiple choice has provided a reduction in burden.

---

Annual Cost to Federal Government: $225,050

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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? No

---

Common Form ICR:  No

---

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: 09/14/2020

---