Maternal and Child Health Bureau Performance Measures for Discretionary Grants

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0298 can be found here:

Documents and Forms

Document Name Document Type
Form C Maternal and Child Health Bureau Performance Measures for Discretionary Grants Form and Instruction
C Attachment C Forms Attachment C_Forms.docx Form and Instruction
B Final_ Change Memo_Attachment B - Detail Sheets.docx Final_ Change Memo_Attachment B - Detail Sheets.docx Form and Instruction
D Final_ Change Memo_Attachment D - Additional Data Elemen Final_ Change Memo_Attachment D - Additional Data Elements.docx Form and Instruction
ATTACH A Social Security Act §501.mht SS Act IC Document
Attachment B-1 - Crosswalk Table.docx Crosswalk Performance Measures IC Document
Attachment E - Public Comments.pdf Public Comments IC Document
Attachment F Summary of Public Comments.xlsx Summary of Public Comments IC Document

Information Collection (IC) Details

IC Title:	Maternal and Child Health Bureau Performance Measures for Discretionary Grants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	C	Attachment C Forms	Attachment C_Forms.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B	Final_ Change Memo_Attachment B - Detail Sheets.docx	Final_ Change Memo_Attachment B - Detail Sheets.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D	Final_ Change Memo_Attachment D - Additional Data Elements.docx	Final_ Change Memo_Attachment D - Additional Data Elements.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	21,600	21,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SS Act	ATTACH A Social Security Act §501.mht	03/22/2016
Crosswalk Performance Measures	Attachment B-1 - Crosswalk Table.docx	03/22/2016
Public Comments	Attachment E - Public Comments.pdf	03/22/2016
Summary of Public Comments	Attachment F Summary of Public Comments.xlsx	03/22/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.