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Federal forms, ICRs, and supporting documents

Information Collection

Application/Annual Report with Needs Assessment Summary

IC 6398 under ICR 202503-0915-002 · OMB 0915-0172.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Application/Annual Report with Needs Assessment Summary
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Title V Maternal and Child Health Services Block Grant to States Program Guidance Forms for the Title V Application/ Annual Report 0172 Revised Form 10.6.23.docx Yes Yes Fillable Fileable
Form and Instruction 1 (03.25 Version) MCHB_Guidance and Forms for the Title V Application Annual Report 1B_MCHB_0915-0172_MCHB_Guidance and Forms for the Title V Application Annual Report REDLINE.docx Yes Yes Fillable Fileable

Health Health Care Services

 

59 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 59 0 0 0 0 59
Annual IC Time Burden (Hours) 17,464 0 0 0 0 17,464
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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