Crosswalk of Changes

OMB Number: XXXX
Expiration Date: Placeholder

Health Resources and Services
Administration
Maternal and Child Health Bureau
Discretionary Grant Performance Measures
OMB No. 0915-0298
Expires: 8/31/2025
Attachment B-1
Crosswalk of Proposed to Prior
Performance Measures
OMB Clearance Package
Public Burden Statement: The purpose of this information collection is to obtain performance data for the
following: grantee monitoring, program planning, and performance reporting. In addition, these data will
facilitate the ability to demonstrate alignment between MCHB discretionary programs and the MCH Title V
Block Grant program to quantify outcomes across MCHB. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. The OMB control number for this information collection is 0915-0298 and it is valid until
XXXX. Public reporting burden for this collection of information is estimated to average XX hours per
response, including the time for reviewing instructions, searching existing data sources, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance
Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.

OMB Number: XXXX
Expiration Date: Placeholder

DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

Health Equity

CB 1

CB 3

CB 4

CB 5

CB 6

CB 8

WMH 1

WMH 2

Measure
Status
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package

Supporting
Text Status

Prior PM
Name (if
applicable)

Core 3

Topic

Data Source

Health Equity

Grantee selfreport

State Capacity for Advancing
the Health of MCH
Populations

Grantee selfreport

Impact Measurement

Grantee selfreport

Sustainability

Grantee selfreport

Scientific Publications

Grantee selfreport

Products

Grantee selfreport

Quality Improvement

Grantee selfreport

Prenatal Care

Grantee selfreport or HS
Data
Collection

Perinatal/ Postpartum Care

Grantee selfreport or HS
Data
Collection

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

WMH 3

WMH 4

PIH 1

PIH 2

PIH 3

CH 1

CH 2

CH 3

CH 4

CSHCN 1

Measure
Status
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Well Woman Visit/
Preventive Health Care

Grantee selfreport or HS
Data
Collection

Depression Screening

Grantee selfreport or HS
Data
Collection

Safe Sleep

Grantee selfreport or HS
Data
Collection

Breastfeeding

Grantee selfreport or HS
Data
Collection

Newborn Screening

Grantee selfreport or HS
Data
Collection

Well Child Visit

Grantee selfreport or HS
Data
Collection

Quality of Well Child Visit

Grantee selfreport

Developmental Screening

Grantee selfreport or HS
Data
Collection

Injury Prevention

Grantee selfreport

Family Engagement

Grantee selfreport

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

CSHCN 2

CSHCN 3

AH 1

AH 2

AH 3

LC 1

LC 2

LC 3
Direct and
Enabling
Services

Measure
Status
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
New

Training and
Workforce
Development

New

Partnerships
and
Collaboration

New

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Access to and Use of Medical
Home

Grantee selfreport

Transition to Adult Health
Care

Grantee selfreport

Adolescent Well Visit

Grantee selfreport

Injury Prevention

Grantee selfreport

Screening for Major
Depressive Disorder

Grantee selfreport

Adequate Health Insurance
Coverage

Grantee selfreport or HS
Data
Collection

Tobacco and eCigarette
Cessation

Grantee selfreport or HS
Data
Collection

Oral Health

Grantee selfreport

Direct and Enabling Services

Grantee selfreport

Training to build knowledge,
skills, and/or capacity of
future and practicing MCH
workforce members
Building/ maintaining/
strengthening partnerships
and collaboration

Grantee selfreport
Grantee selfreport

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

Measure
Status

Engagement
of Persons
with Lived
Experience

New

Technical
Assistance

New

Outreach and
Education

New

Research

New

Guidelines
and Policy
Data and
Information
Systems
Quality
Improvement
and
Evaluation

New
New

New

Knowledge
Change

New

Behavior
Change

New

Training 01

Training 02

Training 03

Training 04

Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic
Engagement of persons with
lived experience, including
family engagement and other
persons with lived experience
Technical assistance to
support organizational needs
or accelerate programmatic
outcomes
Outreach and education,
including dissemination of
research findings
Conducting research and/or
providing infrastructure for
research
Developing or implementing
guidelines or policies
Improving other
organizations’ ability to
collect, access, and link data
Quality improvement and
implementing/testing
strategies and scaling up
successful strategies
Changes in a target
population’s knowledge
resulting from program
activities/interventions
Changes in a target
population’s behavior
resulting from program
activities/interventions

Data Source
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport
Grantee selfreport

MCH Training Program and
Healthy Tomorrows Family
Member/ Youth/ Community
Member participation

Grantee selfreport

MCH Training Program and
Healthy Tomorrows Cultural
Competence

Grantee selfreport

Healthy Tomorrows Title V
Collaboration

Grantee selfreport

Title V Collaboration

Grantee selfreport

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

Training 05

Training 06

Training 07

Training 08

Training 09

Training 10

Training 11

Training 12

Training 14

Measure
Status
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Included in
2023, no
changes from

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Policy

Grantee selfreport

Diversity of Long-Term
Trainees

Grantee selfreport

MCH Pipeline Program –
Work with MCH Populations

Grantee selfreport

MCH Pipeline Program –
Work with Underserved or
Vulnerable Populations

Grantee selfreport

MCH Pipeline - Graduate
Program Enrollment

Grantee selfreport

Leadership

Grantee selfreport

Work with MCH Populations

Grantee selfreport

Interdisciplinary Practice

Grantee selfreport

Medium-Term Trainees Skill
and Knowledge

Grantee selfreport

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

Training 15

EMSC 01

EMSC 02

EMSC 03

EMSC 04

EMSC 05

EMSC 06

EMSC 07

EMSC 08

Measure
Status
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Included in
2023, no
changes from
prior OMB

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Consultation and Training for
Mental and Behavioral Health

Grantee selfreport

Using NEMSIS Data to
Identify Pediatric Patient Care
Needs

Grantee selfreport

Pediatric Emergency Care
Coordination

Grantee selfreport

Use of Pediatric-Specific
Equipment

Grantee selfreport

Pediatric Medical
Emergencies

Grantee selfreport

Pediatric Traumatic
Emergencies

Grantee selfreport

Written Interfacility Transfer
Guidelines that Contain All
Components

Grantee selfreport

Written Inter-facility Transfer
Agreements That Cover
Pediatric Patients

Grantee selfreport

Established Permanence of
EMSC

Grantee selfreport

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

EMSC 09

EMSC 10

Healthy Start
Site Form

HS 01

HS 02

HS 03

HS 04

HS 05

HS 06

Measure
Status
approved
package
Included in
2023, no
changes from
prior OMB
approved
package
New
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Established Permanence of
EMSC by Integrating EMSC
Priorities into
Statutes/Regulations

Grantee selfreport

Prehospital Emergency
Medical Services Pediatric
Readiness Recognition
Program

Grantee selfreport

Healthy Start Site Information

Grantee selfreport or HS
Data
Collection

Reproductive Life Plan

Grantee selfreport or HS
Data
Collection

Usual Source of Care

Grantee selfreport or HS
Data
Collection

Interconception Planning

Grantee selfreport or HS
Data
Collection

Intimate Partner Violence
Screening

Grantee selfreport or HS
Data
Collection

Father/ Partner Involvement
during Pregnancy

Grantee selfreport or HS
Data
Collection

Father and/or Partner
Involvement with Child 0-24
Months

Grantee selfreport or HS
Data
Collection

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

HS 07

HS 08

HS 09

Measure
Status
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
New

HS 10

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Daily Reading

Grantee selfreport or HS
Data
Collection

Community Action Network
Implementation

Grantee selfreport or HS
Data
Collection

Community Action Network
Participation

Grantee selfreport or HS
Data
Collection

Prenatal Care
New

HS 11

Perinatal/ Postpartum Care
New

HS 12

Well Woman Visit/
Preventive Health Care

New
HS 13

Depression Screening
New

HS 14

Safe Sleep
New

HS 15

Breastfeeding
New

HS 16

Well Child Visit
New

HS 17
HS 18

New

Adequate Health Insurance
Coverage
Prenatal Tobacco and
eCigarette Use

Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

Measure
Status

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

New
HS 19

Low Birthweight
New

HS 20

Preterm Birth
New

HS 21

F2F 1

Financial
Form

Form 3

Form 5

Project
Abstract

Form 7

Project
Abstract –

Infant Mortality
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in

Form 1

Form 6

Form 8

Data Source
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection
Grantee selfreport or HS
Data
Collection

National Leadership for
Families with Children with
Special Health Needs

Grantee selfreport

MCHB Project Budget
Details

Grantee selfreport

Budget Details by Types of
Individuals Served

Grantee selfreport

Number of Individuals Served
(Unduplicated)

Grantee selfreport

Maternal & Child Health
Discretionary Grant Project
Abstract

Grantee selfreport

Discretionary Grant Project
Summary Data and
Demographics

Grantee selfreport

MCH Discretionary Grant
Project Abstract (For
Research Projects ONLY)

Grantee selfreport

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

Measure
Status

Research
Projects Only

prior OMB
approved
package
Removed
since prior
OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package

Form 9

Form 10

Technical
Assistance/
Collaboration
Form
Products,
Publications
and
Submissions
Data
Collection
Form
Faculty and
Staff
Information

Short-Term
Trainees

MediumTerm
Trainees

Long-Term
Trainees

Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Program-Specific Project
Performance/Outcome
Measures

Grantee selfreport

Program-Specific and Project
Developed Measures

Grantee selfreport

Technical
Assistance/Collaboration

Grantee selfreport

List of products, publications
and submissions addressing
maternal and child health

Grantee selfreport

Personnel contributing to
MCH training project

Grantee selfreport

Short-Term Trainee
Information

Grantee selfreport

Medium-Term Trainee
Information

Grantee selfreport

Long-Term Trainee
Information

Grantee selfreport

OMB Number: XXXX
Expiration Date: Placeholder
DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance
Measure

Measure
Status

Former LongTerm
Trainees

Revised in
2023,
included in
prior OMB
approved
package
Revised in
2023,
included in
prior OMB
approved
package
Removed
since prior
OMB
approved
package

LEAP
Trainee
Information

Continuing
Education
Form

Supporting
Text Status

Prior PM
Name (if
applicable)

Topic

Data Source

Former Long-Term Trainee
Information

Grantee selfreport

LEAP Trainee Information

Grantee selfreport

Continuing Education

Grantee selfreport