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

OMB 0920-1257

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.

The latest form for Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant expires 2022-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1257 Preventive Health and Health Services Block Grant Assessment Form and Instruction
Attachment 2- Authorizing Legis 42_USC_PHHSBG_Current_2021.pdf Supplementary Document
Attachment 3- PHHS Block Grant Measurement Framework_Vers1.5 updated cz.docx Supplementary Document
Attachment 7 - Privacy Impact Assessment.pdf Supplementary Document
Attachment 8- Non-Research Determination.pdf Supplementary Document
Attachment 1- List of PHHS Block Grant Grantees.docx Supplementary Document
30 day FRN_PHHS Block Grant Assessment Extension_2022 01 24.docx Supplementary Document
PHHS Block Grant_Statement B _2022 04 13.docx Supporting Statement B
PHHS Block Grant Statement A_2022 04 13.docx Supporting Statement A
Preventive Health and Health Services Block Grant Assessment Form and Instruction

All Historical Document Collections

202204-0920-007 Approved without change	Extension without change of a currently approved collection	2022-04-26
201901-0920-003 Approved with change	New collection (Request for a new OMB Control Number)	2019-02-08