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View ICR - OIRA Conclusion

OMB Control No: 0906-0042	ICR Reference No: 202203-0906-002
Status: Historical Active	Previous ICR Reference No: 202102-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/12/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/09/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2025	36 Months From Approved	04/30/2022
Responses	7,303	0	7,303
Time Burden (Hours)	2,002	0	2,014
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	7,303	7,303	0
Annual Time Burden (Hours)	2,002	2,014	-12
Annual Cost Burden (Dollars)	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: Using Information Technology

Short Statement: 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.

Annual Cost to Federal Government: $1,273,954

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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? Yes

Agency Contact: Elyana Bowman 301 443-3983 enadjem@hrsa.gov