Maternal and Child Health
Jurisdictional Survey Instrument for the Title V MCH Block Grant
Program
Extension without change of a currently approved collection
No
Regular
03/09/2022
Requested
Previously Approved
36 Months From Approved
04/30/2022
7,303
7,303
2,002
2,014
0
0
HRSA/MCHB needs the Title V MCH Block
Grant Jurisdictional MCH Survey to create a mechanism for
jurisdictions to begin collecting, reporting and monitoring key MCH
indicators over time. This data collection will enable the eight
jurisdictions (i.e., American Samoa, Federated States of
Micronesia, Guam, Marshall Islands, Northern Mariana Islands,
Palau, Puerto Rico, and U.S. Virgin Islands) to meet Federal
performance reporting requirements and to demonstrate the impact of
Title V funding relative to MCH outcomes for the U.S. jurisdictions
in reporting on their unique MCH priority needs. Having these data
will allow for better annual reporting by the Federal program
office in reporting to Congress on the jurisdictions’ Title V
program accomplishments.
In order to minimize respondent
burden, data will be collected using tablets, such as iPads, to
capture survey data. The use of tablets presents an efficient and
secure way to collect data. It is not likely that there will be
reliable internet availability in many of the data collection
locations; therefore, the tablets will be loaded with a survey that
can be administered offline, allowing the interviewers to launch
and collect data anywhere.
$1,273,954
No
No
No
No
No
No
Yes
Elyana Bowman 301 443-3983
enadjem@hrsa.gov
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:
(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;
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.
Form 1 MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program
Supporting Statement B.docx
MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program