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 Attachment D: Additional Data Elements	Form and Instruction	Modified	Available
Form 2 Attachment C: Program-Specific Forms	Form and Instruction	Modified	Available
Form 1 Attachment B: Central Forms	Form and Instruction	Modified	Available
Supporting Statement A 0915-0298 - MCHB - DGIS Performance Measures- Revision - 10222026.docx	Supporting Statement A	Uploaded 2026-10-22	Available
Attachment A_Crosswalk of Changes_DGIS OMB 0915-0298 09282026.docx	Supplementary Document	Uploaded 2026-10-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
261604	Attachment D_Additional Data Elements	Form and Instruction	Modified	Attachment D: Additional Data Elements
261602	Attachment C Program Specific Form	Form and Instruction	Modified	Attachment C: Program-Specific Forms
261600	Attachment B Central Forms	Form and Instruction	Modified	Attachment B: Central Forms

ICR Details

OMB Control No: 0915-0298	ICR Reference No: 202610-0915-002
Status: Received in OIRA	Previous ICR Reference No: 202603-0915-002
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/23/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2026
Responses	8,283	9,239
Time Burden (Hours)	16,876	17,615
Cost Burden (Dollars)	0	0

---

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.

---

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

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 42967	07/13/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 66565	10/21/2026
Did the Agency receive public comments on this ICR? No

---

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	Attachment B: Central Forms
Attachment C Program Specific Form	2	Attachment C: Program-Specific Forms
Attachment D_Additional Data Elements	3	Attachment D: Additional Data Elements

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	8,283	9,239	0	-956	0	0
Annual Time Burden (Hours)	16,876	17,615	0	-739	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The requested annual burden decreases from 17,615 to 16,876 hours, a reduction of 739 hours. The reduction reflects removal of the Health Equity and Training 02 forms through previously approved non-substantive changes and removal of Training 03 (Healthy Tomorrows) and Training 04 (MCH Training Program) in this revision. Training 03 and Training 04 are no longer needed because the requested information is collected through the Partnerships and Collaboration form. The five forms otherwise revised in this package contain terminology updates that do not change estimated burden.

---

Annual Cost to Federal Government: $1,153,170

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.     Yes

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

---

Common Form ICR:  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:

(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: 10/23/2026

---