Document
Agency Information Collection Activities: Proposed Collection: Public Comment Request; Information Collection Request Title: Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, OMB No. 0915-0172-Revision
In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit...
SUPPLEMENTARY INFORMATION:
When submitting comments or requesting information, please include the ICR title for reference.
Information Collection Request Title:
Title V Maternal and Child Health Services Block Grant to States Program: OMB No. 0915- 0172—Revision
Abstract:
The Title V Maternal and Child Health (MCH) Services Block Grant to States Program is authorized by Sections 501-509 of Title V of the Social Security Act (42 U.S.C. 701-709). HRSA is updating the
Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report
(Guidance). This Guidance is used annually by the 50 states and nine jurisdictions (the District of Columbia, the Republic of the Marshall Islands, the Federated States of Micronesia, the Republic of Palau, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands; hereafter referred to as “state”) in applying for Block Grants under Title V of the Social Security Act and in preparing the required Annual Report. The updates being proposed by HRSA for this edition of the Guidance continue to support the federal-state partnership that is supported by the Title V MCH Services Block Grant and the state's role in developing a 5-Year Action Plan that addresses its individual priority needs.
Updates to this edition of the Guidance are editorial and technical revisions based on feedback from the states in using the Guidance and Forms since January 2024. Specific updates include the following:
(1) Minor editorial corrections and clarifications to Form 7, Form 10, and Form 12 instructions and the Glossary.
(2) Updates to the short and long titles of the National Performance Measures to improve title accuracy and fulfill Government Accountability Office recommendations to align the National Performance Measures with other HRSA program measures.
Need and Proposed Use of the Information:
Each year, all states are required to submit an Application/Annual Report for federal funds for their Title V MCH Services Block Grant to States Program to HRSA(Sections 505(a) and 506(a)(1) of Title V of the Social Security Act). In addition, the state MCH Services Block Grant programs are required to conduct a state-wide, comprehensive needs assessment every 5 years. The information and instructions for the preparation and submission of this Application/Annual Report are contained in the Guidance.
Likely Respondents:
Likely respondents are state MCH agencies and other MCH stakeholders.
Burden Statement:
Burden in this context means the time expended by persons to generate, maintain, retain, disclose, or provide the information requested. This includes the time needed to review instructions; to develop, acquire, install, and utilize technology and systems for the purpose of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; to train personnel and to be able to respond to a collection of information; to search data sources; to complete and review the collection of information; and to transmit or otherwise disclose the information. The total annual burden hours estimated for this ICR are summarized in the table below.
Total Estimated Annualized Burden Hours
| Form name |
Number of
respondents |
Number of
responses per
respondent |
Total
responses |
Average
burden per
response
(in hours) |
Total burden hours |
| Application and Annual Report without Five-Year Needs Assessment Summary |
59 |
1 |
59 |
116 |
6,844 |
| Total |
59 |
|
59 |
|
6,844 |
The burden estimates presented in the table above are based on previous burden estimates and consultation with a few states. States will use the updated edition of the Guidance to prepare and submit the fiscal year (FY) 2028, FY 2029, and FY 2030 Applications/FY 2026, FY 2027, and FY 2028 Annual Reports, which will not contain the 5-Year Needs Assessment Summary. States will submit the next 5-Year Needs Assessment Summary in 2030, as part of the FY 2031 Application/FY 2029 Annual Report.
HRSA specifically requests comments on: (1) the necessity and utility of the proposed information collection for the proper performance of the agency's functions; (2) the accuracy of the estimated burden; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden.
Maria G. Button,
Director, Executive Secretariat.