OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

[PHIC] Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant

OMB 0920-1257 ยท HHS/CDC.

OMB 0920-1257

This data collection will assess select cross-cutting outputs and outcomes of the PHHS Block Grant and demonstrates the utility of the grant on a national level. Respondents include the 61 Block Grant grantees. Data will be collected using a web-based data collection instrument in fall 2019. The previous survey instrument launched in 2022 will be used. No questions have been added or deleted. Prompts were added to the Q5 and Q8 series to reduce errors.Changes to the Healthy People 2030 Topic Area 25 are expected to ensure compliance with Executive Order 14168.

The latest form for [PHIC] Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant expires 2028-08-31 and is listed under ICR 202506-0920-016.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-1257 Instrument_WEBForm
Form 0920-1257 Instrument_WORDForm
Form 0920-1257 Preventive Health and Health Services Block Grant AssessmentForm
Att 1_PHHS BG Recipients.docxSupplementary Document
Att 1_PHHS BG Recipients.docx Supplementary Document
Att 2_Authorizing Legislation.pdfSupplementary Document
Att 2_Authorizing Legislation.pdf Supplementary Document
Att 3_Measure Framework v1.5.docxSupplementary Document
Att 3_Measure Framework v1.5.docx Supplementary Document
Att 6b_Public Comment.pdfPublic Comments
Att 7_Privacy Impact Assessment.pdfSupplementary Document
Att 7_Privacy Impact Assessment.pdf Supplementary Document
Att 8_Research Determination.pdfSupplementary Document
Att 8_Research Determination.pdf Supplementary Document
Att 9_Invitation Email.docxSupplementary Document
Att 9_Invitation Email.docx Supplementary Document
Att 10_Reminder Email.docxSupplementary Document
Att 10_Reminder Email.docx Supplementary Document
Att 11_Final Reminder Email.docxSupplementary Document
Att 11_Final Reminder Email.docx Supplementary Document
Attachment 2- Authorizing Legis 42_USC_PHHSBG_Current_2021.pdfSupplementary Document
Attachment 2- Authorizing Legis 42_USC_PHHSBG_Current_2021.pdf Supplementary Document
Attachment 3- PHHS Block Grant Measurement Framework_Vers1.5 updated cz.docxSupplementary Document
Attachment 3- PHHS Block Grant Measurement Framework_Vers1.5 updated cz.docx Supplementary Document
Attachment 7 - Privacy Impact Assessment.pdfSupplementary Document
Attachment 7 - Privacy Impact Assessment.pdf Supplementary Document
Attachment 8- Non-Research Determination.pdfSupplementary Document
Attachment 8- Non-Research Determination.pdf Supplementary Document
Attachment 1- List of PHHS Block Grant Grantees.docxSupplementary Document
Attachment 1- List of PHHS Block Grant Grantees.docx Supplementary Document
30 day FRN_PHHS Block Grant Assessment Extension_2022 01 24.docxSupplementary Document
30 day FRN_PHHS Block Grant Assessment Extension_2022 01 24.docx Supplementary Document
1257_SSB_3.27.25.docxSupporting Statement B
1257_SSB_3.27.25.docxSupporting Statement B
1257_SSA_3.27.25.docxSupporting Statement A
1257_SSA_3.27.25.docxSupporting Statement A
Preventive Health and Health Services Block Grant Assessment Form
Preventive Health and Health Services Block Grant Assessment Form
Preventive Health and Health Services Block Grant Assessment Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202506-0920-016 Revision of a currently approved collection 2025-06-25
202506-0920-014 Extension without change of a currently approved collection 2025-06-23 Withdrawn and continue
202204-0920-007 Extension without change of a currently approved collection 2022-04-26 Approved without change
201901-0920-003 New collection (Request for a new OMB Control Number) 2019-02-08 Approved with change