Maternal and Child Health Services Block Grant Application/Annual Report Guidance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 2026 Guidance And Forms for the Title V Application/Annual Report	Form and Instruction	Modified	Available
Comment 5_Bakash_07202026.pdf	Public Comments	Uploaded 2026-07-20	Available
Commebt 4_Kelly_07202026.docx	Public Comments	Uploaded 2026-07-20	Available
Comment 3_ Callan_07202026.docx	Public Comments	Uploaded 2026-07-20	Available
Comment 2_Handler Johnson_07162026.docx	Public Comments	Uploaded 2026-07-16	Available
Comment 1_Turner_Wyoming DOH_06162026.pdf	Public Comments	Uploaded 2026-10-22	Available
Attachment A_Log of 60-day FRN Public Comments 10072026.docx	Supplementary Document	Uploaded 2026-10-21	Available
Supporting Statement A - 0915-0172 - MCHB - Title V Guidance - Revision - 10222026.docx	Supporting Statement A	Uploaded 2026-10-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6398	Guidance and Forms for the Title V Application/Annual Report	Form and Instruction	Modified	2026 Guidance And Forms for the Title V Application/Annual Report

ICR Details

OMB Control No: 0915-0172	ICR Reference No: 202610-0915-003
Status: Received in OIRA	Previous ICR Reference No: 202503-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal and Child Health Services Block Grant Application/Annual Report Guidance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/22/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2026
Responses	59	59
Time Burden (Hours)	6,844	17,464
Cost Burden (Dollars)	0	0

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Abstract: The Application and Annual Report fulfill the requirements of Section 505 and Section 506, respectively, of the Title V legislation. Consistent with previous editions, the updated Application/Annual Report Guidance is designed to allow states flexibility in meeting the unique needs of their MCH populations while enabling the Maternal and Child Health Bureau (MCHB) to meet the Title V legislative requirements, collect and utilize comparative data for addressing national and state MCH priorities, and demonstrate accountability in the use of the Federal Title V funds. The MCHB, in the Health Resources and Services Administration (HRSA), serves as the Health and Human Services (HHS) Secretary’s delegate to collect this information and to review it prior to the award of approximately $590 million annually in state formula grants under the MCH Block Grant. This is a revision request.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Social Security Act of 1935
  

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:
	91 FR 29140	05/19/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 66563	10/21/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Guidance and Forms for the Title V Application/Annual Report	1	2026 Guidance And Forms for the Title V Application/Annual Report

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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	59	59	0	0	0	0
Annual Time Burden (Hours)	6,844	17,464	0	-10,620	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 currently approved annual burden for this information collection is 17,464 hours. The proposed annual burden is 6,844 hours, representing a net decrease of 10,620 hours. The reduction is primarily due to removal of the Five-Year Needs Assessment Summary and its associated burden from the three-year approval period covered by this revision. The proposed approval period will not include submission of a Five-Year Needs Assessment Summary. For the annual Application/Annual Report without the Five-Year Needs Assessment Summary, the estimated average burden per response has been adjusted from 115 hours to 116 hours based on updated burden estimates. For 59 respondents, this changes the annual Application/Annual Report burden from 6,785 hours to 6,844 hours, an increase of 59 hours. After accounting for this adjustment and removal of the 10,679 hours associated with the Five-Year Needs Assessment reporting, the net change is a reduction of 10,620 annual burden hours.

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Annual Cost to Federal Government: $362,328

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: 10/22/2026

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