Information Collection Request

National Healthy Start Evaluation and Quality Assurance

ICR 202503-0915-001 · OMB 0915-0338 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 4_Revised 0915-0338_MCHB_HSMED_Parent Child Form_Redline_03052025 Form and Instruction Modified Available
Form 4_Revised Parent/Child Form Form and Instruction Modified Repair queued
Form 3_Revised Prenatal Form (Revised) Form and Instruction Unchanged Available
Form 3 Prenatal Form Form and Instruction Unchanged Available
Form 3 Prenatal Form Form and Instruction Unchanged Repair queued
Form 1 Demographic Form Form and Instruction Modified Repair queued
Form 2 Background Form Form and Instruction Modified Available
Form 2 Background and Demographic Information Form Form and Instruction Modified Repair queued
0915-0338_MCHB_OMB Nonsubstantive Change Request_03052025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-14 Available
0915-0338_MCHB_OMB Nonsubstantive Change Request_03052025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-14 Repair queued
0915-0338_MCHB_HSMED_Implementation Guide ParentChild Form_Redline_03052025.docx Supplementary Document Uploaded 2025-03-14 Available
0915-0338_MCHB_HSMED_Implementation Guide ParentChild Form_Redline_03052025.docx Supplementary Document Uploaded 2025-03-14 Repair queued
0915-0338_MCHB_HSMED_Implementation Guide Demographic Form_Redline_03052025.docx Supplementary Document Uploaded 2025-03-14 Available
0915-0338_MCHB_HSMED_Implementation Guide Demographic Form_Redline_03052025.docx Supplementary Document Uploaded 2025-03-14 Missing upstream
Healthy Start Data Collection Forms_OMB NonSubstantive Change Request_Nov2024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-12-18 Available
Healthy Start Data Collection Forms_OMB NonSubstantive Change Request_Nov2024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-12-18 Missing upstream
Parent Child Form- MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-20 Available
Parent Child Form- MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-20 Repair queued
Demographic_Form- MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-18 Available
Demographic_Form- MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-18 Repair queued
Demographic_Form- MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-18 Available
Demographic_Form- MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-18 Missing upstream
Prenatal Form-MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-18 Repair queued
Prenatal Form-MCHB- Healthy Start Eval and Quality-0915-0338- 6.18.24.pdf Supplementary Document Uploaded 2024-06-18 Repair queued
MCHB- Healthy Start Evaluation and Quality Assurance NSC- 0915-0338- 06.18.24.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-06-18 Available
MCHB- Healthy Start Evaluation and Quality Assurance NSC- 0915-0338- 06.18.24.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-06-18 Missing upstream
Healthy Start Data Collection Forms_OMB NonSubstantive Change Request_Feb2024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-02-22 Repair queued
Healthy Start Data Collection Forms_OMB NonSubstantive Change Request_Feb2024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-02-22 Repair queued
Revised Supporting Statement _0915-0338_OIRA-07.21.23 rev 9.5.23_clean.docx Supporting Statement A Uploaded 2023-09-12 Available
Revised Supporting Statement _0915-0338_OIRA-07.21.23 rev 9.5.23_clean.docx Supporting Statement A Uploaded 2023-09-12 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
211289 Parent/Child Form Form and Instruction Modified0915-0338_MCHB_HSMED_Parent Child Form_Redline_03052025
211289 Parent/Child Form Form and Instruction Modified
211288 Prenatal Form Form and Instruction UnchangedPrenatal Form (Revised)
211288 Prenatal Form Form and Instruction UnchangedPrenatal Form
211288 Prenatal Form Form and Instruction Unchanged
195559 Background and Demographic Information Form Form and Instruction ModifiedDemographic Form
195559 Background and Demographic Information Form Form and Instruction ModifiedBackground Form
195559 Background and Demographic Information Form Form and Instruction Modified
ICR Details
0915-0338 202503-0915-001
Active 202412-0915-001
HHS/HSA
National Healthy Start Evaluation and Quality Assurance
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/15/2025
Retrieve Notice of Action (NOA) 03/28/2025
  Inventory as of this Action Requested Previously Approved
09/30/2026 09/30/2026 09/30/2026
106,050 0 106,050
48,480 0 48,480
0 0 0

The goal of this ongoing monitoring and evaluation is to assess Healthy Start (HS) progress towards meeting its performance goals. Results from monitoring and evaluation efforts will provide actionable evidence to support the improvement, sustainability, replication, and dissemination of the program. The information collected will be used to obtain consistent information across all 100 grantees about HS, its participants, and its outcomes. Respondents include pregnant women and women of reproductive age that were served by HS and HS staff. This revision seeks to reduce the burden of data collection on grantees and program participants, as well as to focus the evaluation more clearly on progress towards meeting performance goals regarding program impact. In the process, this will ensure that collected data is meaningful for monitoring and evaluation, and that previously separate data systems can be streamlined, thus improving efficiency.

PL: Pub.L. 110 - 339 122 Name of Law: Healthy Start Reauthorization Act of 2007
   US Code: 42 USC 254c-8 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  87 FR 64065 10/21/2022
88 FR 10358 02/17/2023
No

  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 106,050 106,050 0 0 0 0
Annual Time Burden (Hours) 48,480 48,480 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$204,806
No
    No
    No
No
No
No
No
Laura Cooper 301 443-2126 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/28/2025