Maternal Health Annual Report (MHAR)

State Maternal Health Innovation (State MHI) Maternal Health Annual Report (MHAR)

Documents and Forms

Document Name Document Type
Finalized_Instrument_MHAR_Narrative_Guidance.docx Instruction
1 Finalized_Instrument_MHAR Data Table Template Finalized_Instrument_MHAR Data Table Template.xlsx Form

Information Collection (IC) Details

IC Title:	Maternal Health Annual Report (MHAR)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	204	204
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.