HRSA/MCHB needs the Title V MCH Block Grant Jurisdictional MCH Survey to create a mechanism for jurisdictions to begin collecting, reporting and monitoring key MCH indicators over time. This data collection will enable the eight jurisdictions (i.e., American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico, and U.S. Virgin Islands) to meet Federal performance reporting requirements and to demonstrate the impact of Title V funding relative to MCH outcomes for the U.S. jurisdictions in reporting on their unique MCH priority needs. Having these data will allow for better annual reporting by the Federal program office in reporting to Congress on the jurisdictions’ Title V program accomplishments.
The latest form for Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program expires 2022-04-30 and can be found here.
Document Name |
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Form and Instruction |
Form and Instruction |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Supporting Statement B |
Supporting Statement B |
Supporting Statement A |
Supporting Statement A |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-04-10 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2022-11-10 | |
Approved with change |
Extension without change of a currently approved collection | 2022-03-09 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2021-02-02 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2019-10-29 | |
Approved with change |
New collection (Request for a new OMB Control Number) | 2019-02-27 |