Information Collection

Maternal Health Annual Report (MHAR)

IC 271240 under ICR 202409-0906-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Maternal Health Annual Report (MHAR)	Form
Finalized_Instrument_MHAR_Narrative_Guidance.docx	Instruction
1 Finalized_Instrument_MHAR Data Table Template Finalized_Instrument_MHAR Data Table Template.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Finalized_Instrument_MHAR Data Table Template	Finalized_Instrument_MHAR Data Table Template.xlsx		Yes	Yes	Fillable Fileable
Instruction			Finalized_Instrument_MHAR_Narrative_Guidance.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	156	156
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.