Maternal Health Portfolio Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Final Supporting Statement A 10-21-20.docx	Supporting Statement A	Uploaded 2020-10-21	Missing upstream
Attachment C4_Partner Survey Recruitment Letter_clean.docx	Supplementary Document	Uploaded 2020-10-19	Repair queued
Attachment C3_Grantee Web-based Data Collection Recruitment Letter_clean.docx	Supplementary Document	Uploaded 2020-10-19	Repair queued
Attachment C2_Grantee Interview Recruitment Letter_clean.docx	Supplementary Document	Uploaded 2020-10-19	Repair queued
Attachment C1_Project Officer Interview Recruitment Letter.docx	Supplementary Document	Uploaded 2020-10-19	Repair queued
Attachment A_OMB No.0906-xxxx-NEW_85 FR 35099.pdf	Supplementary Document	Uploaded 2020-10-19	Repair queued
Supporting Statement B.docx	Supporting Statement B	Uploaded 2020-10-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
244129	Web-Based Data Collection Tool Question Pool	Other-Survey	New
244128	Partnership Survey	Other-Survey	New
244127	Interview Protocol for HRSA Project Officers	Other-Survey	New
244126	Interview Protocol for MH Portfolio Grantees	Other-Survey	New

ICR Details

OMB Control No:	ICR Reference No: 202010-0906-003
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Maternal Health Portfolio Evaluation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/22/2020

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	387	0
Time Burden (Hours)	167	0
Cost Burden (Dollars)	0	0

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Abstract: The purpose of this project is to gather credible evidence on the activities and impact of the HRSA Maternal Health Portfolio, which can be used to assess how programs were designed and implemented and evaluate their associated outcomes. These findings will be used for future decision making on efforts to address maternal mortality and severe maternal morbidity. Respondents include HRSA Project Officers, MH grantees, and grantee partners.

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Authorizing Statute(s): US Code: 42 USC 912(b)(5)) Section 711(b)(5) Name of Law: SSA
   PL: Pub.L. 115 - 245 501(1)(2) and 701(a)(2) Name of Law: SSA Title V
  

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:
	85 FR 35099	06/08/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 66569	10/20/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Interview Protocol for MH Portfolio Grantees
Interview Protocol for HRSA Project Officers
Partnership Survey
Web-Based Data Collection Tool Question Pool

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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	387	0	0	387	0	0
Annual Time Burden (Hours)	167	0	0	167	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 burden increases from zero (0). The Annual Burden is slightly increased due to ROCIS rounding up the total burden hours.

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Annual Cost to Federal Government: $975,221

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? No

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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: 10/22/2020

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