Healthy Start Evaluation and Capacity Building Support

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 6 Results and Recommendations	Form and Instruction	Modified	Available
Form 4 Participant Survey Spanish	Form and Instruction	Modified	Available
Form 5 Stakeholder Interview	Form and Instruction	Modified	Available
Form 3 Participant Survey	Form and Instruction	Modified	Available
Form 2 Network Survey	Form and Instruction	Modified	Repair queued
Form 1 Program Survey	Form and Instruction	Modified	Available
HS Evaluation_OMB NonSubstantive Change Request_090623.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-09-08	Repair queued
Supporting Statement B_08-15-23_Clean.docx	Supporting Statement B	Uploaded 2023-08-16	Available
Supporting Statement A Healthy Start _response to OMB_08-15-23.docx	Supporting Statement A	Uploaded 2023-08-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257575	Healthy Start Program Survey Instruments	Form and Instruction	Modified	Results and Recommendations
257575	Healthy Start Program Survey Instruments	Form and Instruction	Modified	Participant Survey Spanish
257575	Healthy Start Program Survey Instruments	Form and Instruction	Modified	Stakeholder Interview
257575	Healthy Start Program Survey Instruments	Form and Instruction	Modified	Participant Survey
257575	Healthy Start Program Survey Instruments	Form and Instruction	Modified	Network Survey
257575	Healthy Start Program Survey Instruments	Form and Instruction	Modified	Program Survey
257575	Healthy Start Program Survey Instruments	Instruction	Modified

ICR Details

OMB Control No: 0906-0076	ICR Reference No: 202309-0906-002
Status: Historical Active	Previous ICR Reference No: 202212-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Healthy Start Evaluation and Capacity Building Support
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/12/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/08/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	08/31/2024	08/31/2024
Responses	1,601	0	1,601
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

---

Abstract: The goal of the Healthy Start Program, funded through HRSA’s Maternal and Child Health Bureau (MCHB), is to reduce disparities in maternal and infant health. Using a life course approach, the program has focused on improving the health of mothers, infants, and families in those communities with the highest rates of infant mortality, maternal morbidity and mortality, and other adverse birth outcomes such as prematurity and low birth weight, with an emphasis on racial, ethnic, social, and economic disparities. MCHB has long recognized the importance of addressing health disparities and inequitable access to health services and has continuously conducted assessment and evaluation of the program. Evaluation data are key to the identification of strengths and successes of the Healthy Start programs, as well as opportunities for improvement and development. Evaluation data can be used to improve the programs at the grantee and national levels; data can also demonstrate the value and importance of Healthy Start and provide evidence for the need for continued funding, thus ensuring a stable resource within high-risk communities.

---

Authorizing Statute(s): US Code: 42 USC 254c-8 Title III Part D 330H Name of Law: Public Health Service Act
  

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:
	87 FR 43535	07/21/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 78112	12/21/2022
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Healthy Start Program Survey Instruments	1, 2, 3, 5, 4, 6	Program Survey ,   Network Survey ,   Participant Survey ,   Stakeholder Interview ,   Participant Survey Spanish ,   Results and Recommendations

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	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	1,601	1,601	0	0	0	0
Annual Time Burden (Hours)	600	600	0	0	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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $620,057

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: 09/08/2023

---