Information Collection Request
Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program
ICR 202404-0906-002 · OMB 0906-0042 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0906-0042 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 1 MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program |
Form and Instruction | Modified | Repair queued |
| Form 1 MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program |
Form and Instruction | Unchanged | Repair queued |
 Appendix B_Table 2.docx |
Supplementary Document | Uploaded 2024-04-10 | Available |
| Appendix B_Table 2.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Appendix A_Table 1.docx |
Supplementary Document | Uploaded 2024-04-10 | Available |
| Appendix A_Table 1.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| NSC- MCHB - MCH Jurisdictional Survey - 0906-0042_4.10.24.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-04-10 | Available |
| NSC- MCHB - MCH Jurisdictional Survey - 0906-0042_4.10.24.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-04-10 | Repair queued |
| Jurisdictional Survey OMB Request for Non-Substantive Change_OMB_Final_11.1.22.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2022-11-10 | Available |
| Jurisdictional Survey OMB Request for Non-Substantive Change_OMB_Final_11.1.22.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2022-11-10 | Repair queued |
| Supporting Statement B.docx |
Supporting Statement B | Uploaded 2022-03-09 | Available |
| Supporting Statement B.docx |
Supporting Statement B | Uploaded 2022-03-09 | Repair queued |
| Supporting Statement A Updated 03312022.docx |
Supporting Statement A | Uploaded 2022-03-31 | Available |
| Supporting Statement A Updated 03312022.docx |
Supporting Statement A | Uploaded 2022-03-31 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 235104 |  MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program |
Form and Instruction | Modified | |
| 235104 | MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program |
Form and Instruction | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/HRSA |
| OMB Control No | 0906-0042 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202211-0906-001 |
| Date Submitted to OIRA | 2024-04-10 |
| Requested Expiration Date | 1969-12-31 |