Maternal and Child Health Services Block Grant Application/Annual Report Guidance

Forms and Documents

Document Name	Status
Form 1 Application/Annual Report with Needs Assessment Summary Form and Instruction	Modified
Narrative Instructions_ MCH Block Grant Guidance _10_26_2020-FINAL.docx Supplementary Document	2020-11-15
Attachment B FRNs_OCTOBER_26_2020.docx Supplementary Document	2020-11-15
OCT_22_OMB FY 2020 Supporting Statement.MCH Block Grant Guidance.docx Supporting Statement A	2020-11-15

IC Document Collections

IC ID	Document Title	Status
6398	Application/Annual Report with Needs Assessment Summary Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 202011-0915-001
Status: Received in OIRA	Previous ICR Reference No: 201711-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Services Block Grant Application/Annual Report Guidance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/17/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	59	59
Time Burden (Hours)	7,080	8,437
Cost Burden (Dollars)	0	0

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Abstract: This submission is a request for Office of Management and Budget (OMB) continued approval of the Application/Annual Report Guidance that will be used by the 50 States and nine jurisdictions eligible for State formula grants under the Maternal and Child Health (MCH) Services Block Grant, authorized by Section 501 of Title V of the Social Security Act, PL 101-239. This is a revision request.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Social Security Act of 1935
  

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 36217	06/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 71925	11/12/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application/Annual Report with Needs Assessment Summary	1	Attachment A FORM - MCH Block Grant Guidance_October_26_2020-FINAL.docx

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ICR Summary 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	59	59	0	0	0	0
Annual Time Burden (Hours)	7,080	8,437	0	-1,357	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden increase due to an increase in burden per response; a more accurate estimate has been provided with this revision.

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Annual Cost to Federal Government: $1,035,013

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: 11/17/2020

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