Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program

ICR 202102-0906-001

OMB: 0906-0042

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
 Modified
Supplementary Document
2021-02-02
Supplementary Document
2021-02-02
Justification for No Material/Nonsubstantive Change
2021-02-02
Justification for No Material/Nonsubstantive Change
2019-10-28
Supplementary Document
2019-04-11
Supporting Statement B
2019-02-26
Supporting Statement A
2019-04-10
IC Document Collections
IC ID
Document
Title
Status
235104 Modified
ICR Details
0906-0042 202102-0906-001
Received in OIRA 201910-0906-004
HHS/HRSA
Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program
No material or nonsubstantive change to a currently approved collection   No
Regular 02/02/2021
  Requested Previously Approved
04/30/2022 04/30/2022
7,303 5,955
2,014 1,605
0 0
HRSA/MCHB needs the Title V MCH Block Grant Jurisdictional MCH Survey to create a mechanism for jurisdictions to begin collecting, reporting and monitoring key MCH indicators over time. This data collection will enable the eight jurisdictions (i.e., American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico, and U.S. Virgin Islands) to meet Federal performance reporting requirements and to demonstrate the impact of Title V funding relative to MCH outcomes for the U.S. jurisdictions in reporting on their unique MCH priority needs. Having these data will allow for better annual reporting by the Federal program office in reporting to Congress on the jurisdictions’ Title V program accomplishments.
US Code: 5 USC 5 CFR 1320.5(d)(2) Name of Law: Controlling Paperwork Burdens on the Public
  
None
Not associated with rulemaking
  83 FR 57737 11/16/2018
84 FR 5455 02/21/2019
No
  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 7,303 5,955 0 1,348 0 0
Annual Time Burden (Hours) 2,014 1,605 0 409 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The instruments are survey screeners that the public will not see, therefore, no public burden statement or OMB #s/Exp. Dates are indicated on the documents. Burden increase is due to an increase in the sampling/respondent amounts, as per the Jan 2021 Non-Substantive Change Memo.
$1,273,713
No
    No
    No
No
No
No
Yes
Elyana Bowman 301 443-3983 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/02/2021
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