Grant Report

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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment B - Measures and Detail Sheets_Clean.docx Other-Reporting Requirement/Performa
Attachment B - Measures and Detail Sheets_Clean.docx Other-Reporting Requirement/Performa
Attachment B1 - Crosswalk Table.docx Other-Crosswalk Table
Attachment B1 - Crosswalk Table.docx Other-Crosswalk Table
Attachment C - Financial and Demographic Data Elements_Clean.docx Other-Reporting Requirement/Performa
Attachment C - Financial and Demographic Data Elements_Clean.docx Other-Reporting Requirement/Performa
Attachment D - Additional Data Elements_Clean.docx Other-Reporting Requirement/Performa
Attachment D - Additional Data Elements_Clean.docx Other-Reporting Requirement/Performa

Information Collection (IC) Details

IC Title:	Grant Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Reporting Requirement/Performance Measure	Attachment B - Measures and Detail Sheets_Clean.docx	Yes	Yes	Fillable Fileable
Other-Crosswalk Table	Attachment B1 - Crosswalk Table.docx	Yes	Yes	Fillable Fileable
Other-Reporting Requirement/Performance Measure	Attachment C - Financial and Demographic Data Elements_Clean.docx	Yes	Yes	Fillable Fileable
Other-Reporting Requirement/Performance Measure	Attachment D - Additional Data Elements_Clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	25,200	25,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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