Maternal and Child Health Bureau Performance Measures for Discretionary Grant Information System (DGIS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 DGIS OMB_SSA_Attachment D_Additional Data Elements_2026_03172026	Form and Instruction	Modified	Available
Form 2 DGIS OMB_SSA_Attachment C_Program Specific Forms_2026_03172026	Form and Instruction	Modified	Available
Form 1 DGIS OMB_SSA_Attachment B_Central Forms_2026_03172026	Form and Instruction	Modified	Repair queued
HRSA MCHB DGIS 0915-0298 Change Memo OMB Request for Non-Substantive Change_03172026.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2026-03-17	Available
DGIS OMB_Table of Proposed Changes_Attachment A_ 0915-0298_ MCHB 03172026.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2026-03-17	Available
0915-0298_MCHB_OMB NonSubstantive Change Request_02242025.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-14	Available
DGIS OMB_SSA_Attachment B_Central Forms_nonsub_TC.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-17	Repair queued
HRSA MCHB DGIS 0915-0298 Change Memo OMB Request for Non-Substantive Change.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-17	Available
DGIS OMB_Supporting Statement A_OIRA-12.12.23 Clean.docx	Supporting Statement A	Uploaded 2023-12-21	Available
DGIS OMB_Attachment B1_Crosswalk of Changes_DGIS_CLEAN.pdf	Supplementary Document	Uploaded 2023-08-17	Repair queued
Attachment F - Summary of Public Comments.docx	Supplementary Document	Uploaded 2022-08-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
261604	Attachment D_Additional Data Elements	Form and Instruction	Modified	DGIS OMB_SSA_Attachment D_Additional Data Elements_2026_03172026
261604	Attachment D_Additional Data Elements	Form and Instruction	Modified
261602	Attachment C Program Specific Form	Form and Instruction	Modified	DGIS OMB_SSA_Attachment C_Program Specific Forms_2026_03172026
261602	Attachment C Program Specific Form	Form and Instruction	Modified
261600	Attachment B Central Forms	Form and Instruction	Modified	DGIS OMB_SSA_Attachment B_Central Forms_2026_03172026
261600	Attachment B Central Forms	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0298	ICR Reference No: 202603-0915-002
Status: Active	Previous ICR Reference No: 202502-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Bureau Performance Measures for Discretionary Grant Information System (DGIS)
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: 03/25/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/18/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	12/31/2026	12/31/2026
Responses	9,239	0	9,239
Time Burden (Hours)	17,615	0	17,615
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) for Office of Management and Budget (OMB) approval to revise the collection of information from public and private agencies or organizations engaged in demonstrations, research, training, or other projects that receive funding from the Special Projects of Regional and National Significance (SPRANS) and Community Integrated Service Systems (CISS) federal discretionary grant programs, and other categorical discretionary grant programs.

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Authorizing Statute(s): US Code: 42 USC 701-710 Name of Law: Title V: Maternal and Child Block Health Services Block Grant, Social Security Act
   PL: Pub.L. 111 - 352 0 Name of Law: Govt. Perf. and Results Modernization Act of 2010
   PL: Pub.L. 103 - 62 0 Name of Law: Govt. Perf. and Results Act of 1993
  

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 28566	05/04/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 51331	08/03/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Attachment B Central Forms	1	DGIS OMB_SSA_Attachment B_Central Forms_2026_03172026
Attachment C Program Specific Form	2	DGIS OMB_SSA_Attachment C_Program Specific Forms_2026_03172026
Attachment D_Additional Data Elements	3	DGIS OMB_SSA_Attachment D_Additional Data Elements_2026_03172026

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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	9,239	9,239	0	0	0	0
Annual Time Burden (Hours)	17,615	17,615	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:

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Annual Cost to Federal Government: $1,132,512

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 03/18/2026

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