OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant

ICR 202204-0920-007 · OMB 0920-1257 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1257 Preventive Health and Health Services Block Grant Assessment Form and Instruction Modified Missing upstream
Attachment 2- Authorizing Legis 42_USC_PHHSBG_Current_2021.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
Attachment 3- PHHS Block Grant Measurement Framework_Vers1.5 updated cz.docx Supplementary Document Uploaded 2022-04-25 Repair queued
Attachment 7 - Privacy Impact Assessment.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
Attachment 8- Non-Research Determination.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
Attachment 1- List of PHHS Block Grant Grantees.docx Supplementary Document Uploaded 2022-04-25 Repair queued
30 day FRN_PHHS Block Grant Assessment Extension_2022 01 24.docx Supplementary Document Uploaded 2022-04-25 Repair queued
PHHS Block Grant_Statement B _2022 04 13.docx Supporting Statement B Uploaded 2022-04-25 Repair queued
PHHS Block Grant Statement A_2022 04 13.docx Supporting Statement A Uploaded 2022-04-26 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
234732 Preventive Health and Health Services Block Grant Assessment Form and Instruction Modified
ICR Details
0920-1257 202204-0920-007
Received in OIRA 201901-0920-003
HHS/CDC 0920-1257
Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant
Extension without change of a currently approved collection   No
Regular 04/26/2022
  Requested Previously Approved
12 Months From Approved 04/30/2022
61 61
46 46
0 0
This data collection will assess select cross-cutting outputs and outcomes of the PHHS Block Grant and demonstrates the utility of the grant on a national level. Respondents include the 61 Block Grant grantees. Data will be collected using a web-based data collection instrument in fall 2019.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  87 FR 6560 02/04/2022
87 FR 24307 04/25/2022
No
1
IC Title Form No. Form Name
Preventive Health and Health Services Block Grant Assessment 0920-1257 PHHS Block Grant Coordinators, or designee
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 61 61 0 0 0 0
Annual Time Burden (Hours) 46 46 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$32,455
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Odion Clunis 770 488-0045 [email protected]
  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.
04/26/2022