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pdfOMB Number: XXXX
Expiration Date: Placeholder
Health Resources and Services
Administration
Maternal and Child Health Bureau
Discretionary Grant Performance Measures
OMB No. 0915-0298
Expires: 8/31/2025
Attachment B-1
Crosswalk of Proposed to Prior
Performance Measures
OMB Clearance Package
Public Burden Statement: The purpose of this information collection is to obtain performance data for the
following: grantee monitoring, program planning, and performance reporting. In addition, these data will
facilitate the ability to demonstrate alignment between MCHB discretionary programs and the MCH Title V
Block Grant program to quantify outcomes across MCHB. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. The OMB control number for this information collection is 0915-0298 and it is valid until
XXXX. Public reporting burden for this collection of information is estimated to average XX hours per
response, including the time for reviewing instructions, searching existing data sources, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance
Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
Health Equity
CB 1
CB 3
CB 4
CB 5
CB 6
CB 8
WMH 1
WMH 2
Measure
Status
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Supporting
Text Status
Prior PM
Name (if
applicable)
Core 3
Topic
Data Source
Health Equity
Grantee selfreport
State Capacity for Advancing
the Health of MCH
Populations
Grantee selfreport
Impact Measurement
Grantee selfreport
Sustainability
Grantee selfreport
Scientific Publications
Grantee selfreport
Products
Grantee selfreport
Quality Improvement
Grantee selfreport
Prenatal Care
Grantee selfreport or HS
Data
Collection
Perinatal/ Postpartum Care
Grantee selfreport or HS
Data
Collection
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
WMH 3
WMH 4
PIH 1
PIH 2
PIH 3
CH 1
CH 2
CH 3
CH 4
CSHCN 1
Measure
Status
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Well Woman Visit/
Preventive Health Care
Grantee selfreport or HS
Data
Collection
Depression Screening
Grantee selfreport or HS
Data
Collection
Safe Sleep
Grantee selfreport or HS
Data
Collection
Breastfeeding
Grantee selfreport or HS
Data
Collection
Newborn Screening
Grantee selfreport or HS
Data
Collection
Well Child Visit
Grantee selfreport or HS
Data
Collection
Quality of Well Child Visit
Grantee selfreport
Developmental Screening
Grantee selfreport or HS
Data
Collection
Injury Prevention
Grantee selfreport
Family Engagement
Grantee selfreport
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
CSHCN 2
CSHCN 3
AH 1
AH 2
AH 3
LC 1
LC 2
LC 3
Direct and
Enabling
Services
Measure
Status
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
New
Training and
Workforce
Development
New
Partnerships
and
Collaboration
New
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Access to and Use of Medical
Home
Grantee selfreport
Transition to Adult Health
Care
Grantee selfreport
Adolescent Well Visit
Grantee selfreport
Injury Prevention
Grantee selfreport
Screening for Major
Depressive Disorder
Grantee selfreport
Adequate Health Insurance
Coverage
Grantee selfreport or HS
Data
Collection
Tobacco and eCigarette
Cessation
Grantee selfreport or HS
Data
Collection
Oral Health
Grantee selfreport
Direct and Enabling Services
Grantee selfreport
Training to build knowledge,
skills, and/or capacity of
future and practicing MCH
workforce members
Building/ maintaining/
strengthening partnerships
and collaboration
Grantee selfreport
Grantee selfreport
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
Measure
Status
Engagement
of Persons
with Lived
Experience
New
Technical
Assistance
New
Outreach and
Education
New
Research
New
Guidelines
and Policy
Data and
Information
Systems
Quality
Improvement
and
Evaluation
New
New
New
Knowledge
Change
New
Behavior
Change
New
Training 01
Training 02
Training 03
Training 04
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Engagement of persons with
lived experience, including
family engagement and other
persons with lived experience
Technical assistance to
support organizational needs
or accelerate programmatic
outcomes
Outreach and education,
including dissemination of
research findings
Conducting research and/or
providing infrastructure for
research
Developing or implementing
guidelines or policies
Improving other
organizations’ ability to
collect, access, and link data
Quality improvement and
implementing/testing
strategies and scaling up
successful strategies
Changes in a target
population’s knowledge
resulting from program
activities/interventions
Changes in a target
population’s behavior
resulting from program
activities/interventions
Data Source
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
MCH Training Program and
Healthy Tomorrows Family
Member/ Youth/ Community
Member participation
Grantee selfreport
MCH Training Program and
Healthy Tomorrows Cultural
Competence
Grantee selfreport
Healthy Tomorrows Title V
Collaboration
Grantee selfreport
Title V Collaboration
Grantee selfreport
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
Training 05
Training 06
Training 07
Training 08
Training 09
Training 10
Training 11
Training 12
Training 14
Measure
Status
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Included in
2023, no
changes from
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Policy
Grantee selfreport
Diversity of Long-Term
Trainees
Grantee selfreport
MCH Pipeline Program –
Work with MCH Populations
Grantee selfreport
MCH Pipeline Program –
Work with Underserved or
Vulnerable Populations
Grantee selfreport
MCH Pipeline - Graduate
Program Enrollment
Grantee selfreport
Leadership
Grantee selfreport
Work with MCH Populations
Grantee selfreport
Interdisciplinary Practice
Grantee selfreport
Medium-Term Trainees Skill
and Knowledge
Grantee selfreport
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
Training 15
EMSC 01
EMSC 02
EMSC 03
EMSC 04
EMSC 05
EMSC 06
EMSC 07
EMSC 08
Measure
Status
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Included in
2023, no
changes from
prior OMB
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Consultation and Training for
Mental and Behavioral Health
Grantee selfreport
Using NEMSIS Data to
Identify Pediatric Patient Care
Needs
Grantee selfreport
Pediatric Emergency Care
Coordination
Grantee selfreport
Use of Pediatric-Specific
Equipment
Grantee selfreport
Pediatric Medical
Emergencies
Grantee selfreport
Pediatric Traumatic
Emergencies
Grantee selfreport
Written Interfacility Transfer
Guidelines that Contain All
Components
Grantee selfreport
Written Inter-facility Transfer
Agreements That Cover
Pediatric Patients
Grantee selfreport
Established Permanence of
EMSC
Grantee selfreport
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
EMSC 09
EMSC 10
Healthy Start
Site Form
HS 01
HS 02
HS 03
HS 04
HS 05
HS 06
Measure
Status
approved
package
Included in
2023, no
changes from
prior OMB
approved
package
New
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Established Permanence of
EMSC by Integrating EMSC
Priorities into
Statutes/Regulations
Grantee selfreport
Prehospital Emergency
Medical Services Pediatric
Readiness Recognition
Program
Grantee selfreport
Healthy Start Site Information
Grantee selfreport or HS
Data
Collection
Reproductive Life Plan
Grantee selfreport or HS
Data
Collection
Usual Source of Care
Grantee selfreport or HS
Data
Collection
Interconception Planning
Grantee selfreport or HS
Data
Collection
Intimate Partner Violence
Screening
Grantee selfreport or HS
Data
Collection
Father/ Partner Involvement
during Pregnancy
Grantee selfreport or HS
Data
Collection
Father and/or Partner
Involvement with Child 0-24
Months
Grantee selfreport or HS
Data
Collection
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
HS 07
HS 08
HS 09
Measure
Status
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
New
HS 10
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Daily Reading
Grantee selfreport or HS
Data
Collection
Community Action Network
Implementation
Grantee selfreport or HS
Data
Collection
Community Action Network
Participation
Grantee selfreport or HS
Data
Collection
Prenatal Care
New
HS 11
Perinatal/ Postpartum Care
New
HS 12
Well Woman Visit/
Preventive Health Care
New
HS 13
Depression Screening
New
HS 14
Safe Sleep
New
HS 15
Breastfeeding
New
HS 16
Well Child Visit
New
HS 17
HS 18
New
Adequate Health Insurance
Coverage
Prenatal Tobacco and
eCigarette Use
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
Measure
Status
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
New
HS 19
Low Birthweight
New
HS 20
Preterm Birth
New
HS 21
F2F 1
Financial
Form
Form 3
Form 5
Project
Abstract
Form 7
Project
Abstract –
Infant Mortality
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
Form 1
Form 6
Form 8
Data Source
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
National Leadership for
Families with Children with
Special Health Needs
Grantee selfreport
MCHB Project Budget
Details
Grantee selfreport
Budget Details by Types of
Individuals Served
Grantee selfreport
Number of Individuals Served
(Unduplicated)
Grantee selfreport
Maternal & Child Health
Discretionary Grant Project
Abstract
Grantee selfreport
Discretionary Grant Project
Summary Data and
Demographics
Grantee selfreport
MCH Discretionary Grant
Project Abstract (For
Research Projects ONLY)
Grantee selfreport
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
Measure
Status
Research
Projects Only
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Form 9
Form 10
Technical
Assistance/
Collaboration
Form
Products,
Publications
and
Submissions
Data
Collection
Form
Faculty and
Staff
Information
Short-Term
Trainees
MediumTerm
Trainees
Long-Term
Trainees
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Program-Specific Project
Performance/Outcome
Measures
Grantee selfreport
Program-Specific and Project
Developed Measures
Grantee selfreport
Technical
Assistance/Collaboration
Grantee selfreport
List of products, publications
and submissions addressing
maternal and child health
Grantee selfreport
Personnel contributing to
MCH training project
Grantee selfreport
Short-Term Trainee
Information
Grantee selfreport
Medium-Term Trainee
Information
Grantee selfreport
Long-Term Trainee
Information
Grantee selfreport
OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure
Measure
Status
Former LongTerm
Trainees
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
LEAP
Trainee
Information
Continuing
Education
Form
Supporting
Text Status
Prior PM
Name (if
applicable)
Topic
Data Source
Former Long-Term Trainee
Information
Grantee selfreport
LEAP Trainee Information
Grantee selfreport
Continuing Education
Grantee selfreport
File Type | application/pdf |
File Title | DGIS OMB_Attachment B1_Crosswalk of Changes |
Author | Jesse Lichstein |
File Modified | 2023-04-05 |
File Created | 2023-04-05 |