[PHIC] Preventive Health and Health Services Block Grant

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Annual Progress Report Worksheet	Form and Instruction	Unchanged	Available
Annual Progress Report (subset of Final Progress questions)	Form and Instruction	Unchanged	Repair queued
Annual Progress Report Worksheet	Form and Instruction	Unchanged	Available
Annual Progress Report (subset of Interim Progress questions)	Form and Instruction	Unchanged	Repair queued
Form 0920-0106 WorkPlan Program Questions_REVISED 31MAR2025	Form and Instruction	Modified	Available
Workplan Program Quesions	Form and Instruction	Modified	Available
Work Plan Program Questions	Form and Instruction	Modified	Repair queued
Workplan Start and Advisory Committee Quesions	Form and Instruction	Unchanged	Available
Workplan Start and Advisory Committee Questions	Form and Instruction	Unchanged	Repair queued
0920-0106 Change Request_EO 14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-31	Repair queued
0920-0106 Change Request_EO 14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-31	Repair queued
OCIO_Azure_GSS_AO_Decision_Letter_(High)_09152023.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
OCIO_Azure_GSS_AO_Decision_Letter_(High)_09152023.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
Copy_of_Privacy_Impact_Assessment_PIA_bl.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
Copy_of_Privacy_Impact_Assessment_PIA_bl.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att N_BGIS_2023 OMB pkg Crosswalk of changes_011024.xlsx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att N_BGIS_2023 OMB pkg Crosswalk of changes_011024.xlsx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att M_Announcements on BGIS Landing Page_Screenshot.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att M_Announcements on BGIS Landing Page_Screenshot.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att L_STARS Project Determination.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att L_STARS Project Determination.docx	Supplementary Document	Uploaded 2024-01-29	Missing upstream
Att K_Privacy Act Checklist_BGIS 2023.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att K_Privacy Act Checklist_BGIS 2023.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att I_0920-0106_60dayFRN_05012023.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att I_0920-0106_60dayFRN_05012023.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
Statement B-Block Grant ICR_2023.docx	Supporting Statement B	Uploaded 2024-01-29	Repair queued
Statement B-Block Grant ICR_2023.docx	Supporting Statement B	Uploaded 2024-01-29	Repair queued
Statement A-Block Grant ICR_2023_final.docx	Supporting Statement A	Uploaded 2024-01-12	Repair queued
Statement A-Block Grant ICR_2023_final.docx	Supporting Statement A	Uploaded 2024-01-12	Repair queued
Att B_Block Grant Authorizing Legislation 1981 and 1992.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att B_Block Grant Authorizing Legislation 1981 and 1992.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att A_List of PHHS Block Grant Recipients.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued
Att A_List of PHHS Block Grant Recipients.docx	Supplementary Document	Uploaded 2024-01-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
264761	Annual Progress Report (subset of Final Progress questions)	Form and Instruction	Unchanged	Annual Progress Report Worksheet
264761	Annual Progress Report (subset of Final Progress questions)	Form and Instruction	Unchanged
264760	Annual Progress Report (subset of Interim Progress questions)	Form and Instruction	Unchanged	Annual Progress Report Worksheet
264760	Annual Progress Report (subset of Interim Progress questions)	Form and Instruction	Unchanged
264759	Work Plan Program Questions	Form and Instruction	Modified	WorkPlan Program Questions_REVISED 31MAR2025
264759	Work Plan Program Questions	Form and Instruction	Modified	Workplan Program Quesions
264759	Work Plan Program Questions	Form and Instruction	Modified
264758	Workplan Start and Advisory Committee Questions	Form and Instruction	Unchanged	Workplan Start and Advisory Committee Quesions
264758	Workplan Start and Advisory Committee Questions	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0106	ICR Reference No: 202503-0920-038
Status: Historical Active	Previous ICR Reference No: 202401-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0106-25-0083
Title: [PHIC] Preventive Health and Health Services Block Grant
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/06/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/14/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2027	03/31/2027	03/31/2027
Responses	244	0	244
Time Burden (Hours)	1,403	0	1,403
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this colledtion is to ensure that the CDC PHHS Block Grant program managers and PHHS Block Grant recipients account for funds in accordance with legislative mandates by providing information on work through work plans and annual reports. CDC will use the Block Grant Information System to monitor awardees' progress, identify activities and personnel supported with Block Grant funding, and conduct compliance reviews of Block Grant awardees. Non-Substantive Change Request is submitted to modify 0920-0106 package to comply with EO 14168.

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Authorizing Statute(s): US Code: 42 USC 300w-300w-8 Name of Law: Preventive Health and Health Services Block Grants
   US Code: 45 USC 96.1-96.17 Name of Law: Block Grants
   PL: Pub.L. 102 - 531 101-104 Name of Law: Preventive Health and health Services Block Grant
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 26549	05/01/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 5236	01/26/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Annual Progress Report (subset of Final Progress questions)	n/a	Annual Progress Report Worksheet
Annual Progress Report (subset of Interim Progress questions)	n/a	Annual Progress Report Worksheet
Work Plan Program Questions	n/a, 0920-0106	Workplan Program Quesions ,   WorkPlan Program Questions_REVISED 31MAR2025
Workplan Start and Advisory Committee Questions	n/a	Workplan Start and Advisory Committee Quesions

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ICR Summary of Burden

table that charts list of burden

	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	244	244	0	0	0	0
Annual Time Burden (Hours)	1,403	1,403	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Recipient Information Collection has been deleted from the burden table (-122 annualized burden hours). The BGIS will retain this information, however, the one-time burden of entering the Recipient Information was accounted for in the previous approval period.

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Annual Cost to Federal Government: $288,219

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/14/2025

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