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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202203-0906-002 · OMB 0906-0042 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 1 MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program Form and Instruction Modified Repair queued
Supporting Statement B.docx Supporting Statement B Uploaded 2022-03-09 Repair queued
Supporting Statement A.docx Supporting Statement A Uploaded 2022-03-09 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
235104 MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program Form and Instruction Modified
ICR Details
0906-0042 202203-0906-002
Received in OIRA 202102-0906-001
HHS/HRSA
Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program
Extension without change of a currently approved collection   No
Regular 03/09/2022
  Requested Previously Approved
36 Months From Approved 04/30/2022
7,303 7,303
2,002 2,014
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
  86 FR 50365 09/08/2021
87 FR 12179 03/03/2022
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 7,303 0 0 0 0
Annual Time Burden (Hours) 2,002 2,014 0 -12 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Using Information Technology
In order to minimize respondent burden, data will be collected using tablets, such as iPads, to capture survey data. The use of tablets presents an efficient and secure way to collect data. It is not likely that there will be reliable internet availability in many of the data collection locations; therefore, the tablets will be loaded with a survey that can be administered offline, allowing the interviewers to launch and collect data anywhere.
$1,273,954
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.
03/09/2022