Federal Register / Vol. 88, No. 179 / Monday, September 18, 2023 / Notices 63963 

1The following nine jurisdictions receive Title V 

Maternal and Child Health Block Grant Program 

funding: 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 US Virgin 

Islands, Guam, American Samoa, and the 

Commonwealth of the Northern Mariana Islands. 

documents pertaining to an adverse 

event report have been assembled and 

filed in accordance with MoCRA, we 

expect the records retention burden to 

be minimal, as we believe most 

responsible persons would normally 

keep this kind of record for at least 

several years after creating the 

document, as a matter of usual and 

customary business practice. 

Dated: September 13, 2023. 

Lauren K. Roth, 

Associate Commissioner for Policy. 

[FR Doc. 2023–20139 Filed 9–15–23; 8:45 am] 

BILLING CODE 4164–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Agency Information Collection 

Activities: Submission to OMB for 

Review and Approval; Public Comment 

Request; 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 

AGENCY: Health Resources and Services 

Administration (HRSA), Department of 

Health and Human Services. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act of 1995, 

HRSA submitted an Information 

Collection Request (ICR) to the Office of 

Management and Budget (OMB) for 

review and approval. Comments 

submitted during the first public review 

of this ICR will be provided to OMB. 

OMB will accept further comments from 

the public during the review and 

approval period. OMB may act on 

HRSA’s ICR only after the 30-day 

comment period for this notice has 

closed. 

DATES: Comments on this ICR should be 

received no later than October 18, 2023. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under Review—Open for 

Public Comments’’ or by using the 

search function. 

FOR FURTHER INFORMATION CONTACT: To 

request a copy of the clearance requests 

submitted to OMB for review, email 

Joella Roland, the HRSA Information 

Collection Clearance Officer, at 

paperwork@hrsa.gov or call (301) 443– 

3983. 

SUPPLEMENTARY INFORMATION: 

Information Collection Request Title: 

Title V Maternal and Child Health 

(MCH) Services Block Grant to States 

Program: Guidance and Forms for the 

Title V Application/Annual Report 

OMB No. 0915–0172—Revision 

Abstract: The Title V 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 

MCH Services Block Grant to States 

Program: Guidance and Forms for the 

Title V Application/Annual Report 

(‘‘Guidance’’). The updated edition will 

be the tenth edition of the Guidance. 

This Guidance is used annually by the 

50 states and nine jurisdictions 1

(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’s 

Maternal and Child Health Bureau for 

the tenth 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. These 

proposed updates build on and further 

refine the reporting structure and vision 

that was outlined in the previous ninth 

edition. As such, they are intended to 

enable a state to articulate a 

comprehensive description of its Title V 

program activities and its leadership 

efforts in advancing and assuring a 

public health system that serves the 

MCH population. HRSA’s proposed 

updates to the tenth edition of the 

Guidance were informed by 

consultation with State Title V MCH 

agencies, and by comments received 

from State Title V program leadership, 

national MCH leaders, other MCH 

stakeholders, and the public. A 60-day 

notice was published in the Federal 

Register on May 5, 2023, vol. 88, No. 87; 

pp. 29135–37 FR 29135–37. HRSA 

received 170 comments on the proposed 

updates to the tenth edition of the 

Guidance, from a variety of responders, 

including state Title V Programs, other 

state agencies, public health 

organizations, universities, members of 

the community, and other stakeholders. 

Of the 170 comments, 80 requested that 

stillbirth be addressed in the Guidance, 

and 71 requested that the oral health 

performance measures be retained as a 

national performance measure. The 

remainder of 19 comments included 

suggestions for clarifying instructions in 

certain sections of the Guidance, 

including examples of partnership with 

non-governmental organizations and 

family organizations, or responding to 

reporting burden on the universal 

performance measures. HRSA 

considered all public comments as part 

of its deliberative process in finalizing 

updates to the tenth edition of the Title 

V MCH Services Block Grant to States 

Program: Guidance and Forms for the 

Title V Application/Annual Report. 

A discussion of the public comments 

received during the 60-day comment 

period and HRSA’s response to the 

comments is set below: 

(1) Revised Approach for Interim-Year 

Reporting: States and diverse 

stakeholders expressed strong support 

for the proposed approach that would 

allow states to decide whether updates 

are needed to numerous sections of the 

guidance during interim years 2 through 

5, following submission of the 5-year 

Needs Assessment in year 1. In response 

to these comments, HRSA will maintain 

this approach in the tenth edition of the 

Guidance. 

(2) Streamlining and Reorganizing of 

the Guidance: States and diverse 

stakeholders expressed strong support 

for the proposed approach of 

streamlining and reorganizing the 

requirements for state narrative 

reporting, in order to eliminate 

duplication. In response to these 

comments, HRSA will maintain this 

approach in the tenth edition of the 

Guidance. 

(3) Family and Community 

Partnership: HRSA received comments 

related to clarifying expectations on 

reporting about family and community 

partnerships. In response to these 

comments, expectations around state 

Title V reporting on family and 

community partnerships will be 

clarified, such as reporting on 

partnership with HRSA’s Family-toFamily Health Information Centers, 

discussion on the impact these 

partnerships have on the MCH 

population, and their value in 

improving outcomes. 

(4) Health Equity: Comments received 

from states and stakeholders support the 

stronger emphasis on health equity, 

including it being a guiding principle of 

the Title V Program. In response to these 

comments, HRSA will maintain this 

approach in the tenth edition of the 

Guidance. 


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63964 Federal Register / Vol. 88, No. 179 / Monday, September 18, 2023 / Notices 

(5) Children and Youth With Special 

Health Care Needs: Several commenters 

provided suggestions to enhance the 

instructions related to the children with 

special health care needs (CSHCN) 

domain, with a focus on the Blueprint 

for Change: A National Framework for 

a System of Services for Children and 

Youth with Special Health Care Needs, 

family engagement, and the six core 

outcomes for a CSHCN system of care. 

In response to these comments, HRSA 

will clarify the instructions in the tenth 

edition of the Guidance for describing 

the CSHCN system of care and the 

Annual Report and Application 

narrative for the CSHCN population 

domain. 

(6) Oral Health Performance Measure: 

HRSA received comments from 

stakeholders that requested to retain the 

preventive dental visit as a National 

Performance Measure (NPM), rather 

than classify it as a Standardized 

Measure as proposed during the 60-day 

comment period. Based on comments 

received from stakeholders and 

members of the community, HRSA will 

retain the preventive dental visit as an 

NPM. 

(7) Reporting on Stillbirth: Comments 

were received during the 60-day 

comment period that requested a change 

to National Outcome Measure 6 from 

‘‘perinatal mortality rate per 1,000 live 

births plus fetal deaths’’ to a stillbirthfocused measure. HRSA will maintain 

the perinatal mortality measure as 

defined; however, based on these 

comments received from stakeholders 

and members of the community, HRSA 

will add a National Outcome Measure 

for stillbirth rate defined as, ‘‘number of 

fetal deaths at 20 or more weeks 

gestation per 1,000 live births plus fetal 

deaths.’’ In addition, HRSA will update 

the narrative in the tenth edition of the 

Guidance to revise the last sentence of 

III.B.3.a System of Care for Mothers, 

Children, and Families to include 

bereavement and stillbirth, as follows: 

‘‘In describing the state’s system of care 

for mothers, infants, and children, the 

role of the Title V program in addressing 

key MCH issues, which may include 

access to quality services, prenatal and 

postpartum care, maternal morbidity 

and mortality, stillbirth, newborn 

screening, infant mortality, preventive 

and primary care services for children 

and adolescents, immunizations, injury 

prevention, oral health, behavioral and 

mental health, bereavement, and/or 

substance use, should be clearly 

identified.’’ HRSA also added an 

example for Form 5b, pregnant women, 

around health promotion campaigns 

that address stillbirth and postpartum 

depression. Comments were also 

received suggesting updates to the 

Healthy People 2030 objective for 

stillbirth, although this was not 

proposed in the 60-day notice. These 

comments were not accepted, as HRSA 

does not have the authority to modify 

Healthy People 2030 objectives. 

(8) Universal Measures: A few states 

commented that the requirement of 

reporting on the two universal measures 

increased burden to the states, when the 

universal measures do not align with 

state priorities. The Title V statute 

authorizes the Secretary of Health and 

Human Services to identify priorities of 

national significance and require 

reporting on those priorities. The two 

selected universal measures, Postpartum 

Visit and Medical Home, are selected as 

national priorities because of their focus 

on access and quality of essential 

primary and preventive care for mothers 

and children, including children with 

special health care needs. To help 

reduce burden, instructions will clarify 

that only one Evidence-based or 

-informed Strategy Measure is required 

for Medical Home. HRSA has removed 

the requirement to discuss Medical 

Home in the Adolescent Health Domain, 

emphasizing reporting in the Child 

Health Domain. States may optionally 

report on Medical Home in the 

Adolescent Health Domain in addition 

to the required Child Health and 

CSHCN domains. HRSA did not receive 

specific comments on the Postpartum 

Visit universal measure. 

(9) Standardized Measures: No 

comments were submitted in response 

to the proposal to update the Guidance 

with a new set of Standardized 

Measures to select as State Performance 

Measures. Accordingly, HRSA will 

retain this update to the tenth edition of 

the Guidance. 

(10) Form 7 Title V Program 

Workforce: HRSA received comments 

requesting clarifications to the 

instructions and data fields in Form 7: 

Title V Program Workforce. In response 

to comments received from state Title V 

programs and stakeholders, Form 7 

instructions will be clarified to better 

define what is a full-time employee, the 

relationship between the data fields, 

and the data being collected about 

positions lost over the past 12 months. 

(11) Technical Revisions: Several 

commenters suggested technical 

revisions to the Guidance, which 

included edits to terminology, provided 

examples of possible revisions, and 

clarifications to the narrative reporting 

instructions. In response to these 

comments, HRSA will modify the tenth 

edition of the Guidance to incorporate 

these revisions to terminology, 

examples, and clarifications to 

instructions. Revisions will include: 

a. Part One: Background and 

Administrative Information: 

i. IV.B: Update Figure 2 to better 

display the performance measure 

framework. 

b. Part Two: Application/Annual 

Report Instructions. 

i. II: Clarify instructions concerning 

the use of State Performance Measures 

to address a priority need. 

ii. II: Clarify instructions on the 

option to select a priority population, in 

addition to an NPM overall. 

iii. III.B.3.b: Include the definition of 

a well-functioning system of care. 

iv. III.B.3.c: Include Medicaid Core 

Set measures as part of the list of what 

to include in the state’s narrative that 

describes areas of coordination between 

the state Title V program and Medicaid, 

and expanded examples of health care 

financing. 

v. III.C.1.b.ii.c: Expand the workforce 

narrative to include the number of 

parents and family members, including 

CSHCN and families, who are on a 

state’s Title V program staff. 

vi. III.C.1.c: Include narrative on the 

ways stakeholders, including families, 

constituents, and family-led 

organizations, were involved in 

identifying priority needs. 

vii. III.E: Reorder the columns of the 

State Action Plan Table to the following 

order: Priority Needs, 5-Year Objectives, 

Strategies, Evidence-based or -Informed 

Strategy Measures, National and State 

Performance Measures, and National 

and State Outcome Measures. 

c. Part Three: Reporting Forms. 

i. Form 10: Use consistent terms to 

describe ‘‘annual objective’’. 

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 the HRSA’s MCHB 

(Section 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 Title V Maternal and 

Child Health Services Block Grant to 

State Program: Guidance and Forms for 

the Title V Application/Annual Report. 

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, 


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Federal Register / Vol. 88, No. 179 / Monday, September 18, 2023 / Notices 63965 

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 5-Year Needs Assessment Summary .......................................................... 59 1 59 115 6,785 

Application and Annual Report with 5-Year Needs Assessment Summary ................................................................. 59 1 59 181 10,679 

Total .............................................................................. 59 ........................ 59 ........................ 17,464 

Maria G. Button, 

Director, Executive Secretariat. 

[FR Doc. 2023–20102 Filed 9–15–23; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Agency Information Collection 

Activities: Proposed Collection: Public 

Comment Request; Information 

Collection Request Title: Maternal 

Health Portfolio Evaluation Design, 

OMB No. 0906–0059, Revision 

AGENCY: Health Resources and Services 

Administration (HRSA), Department of 

Health and Human Services. 

ACTION: Notice. 

SUMMARY: 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 an Information Collection 

Request (ICR), described below, to the 

Office of Management and Budget 

(OMB). Prior to submitting the ICR to 

OMB, HRSA seeks comments from the 

public regarding the burden estimate, 

below, or any other aspect of the ICR. 

DATES: Comments on this ICR should be 

received no later than November 17, 

2023. 

ADDRESSES: Submit your comments to 

paperwork@hrsa.gov or mail the HRSA 

Information Collection Clearance 

Officer, Room 14N136B, 5600 Fishers 

Lane, Rockville, MD 20857. 

FOR FURTHER INFORMATION CONTACT: To 

request more information on the 

proposed project or to obtain a copy of 

the data collection plans and draft 

instruments, email paperwork@hrsa.gov 

or call Joella Roland, the HRSA 

Information Collection Clearance 

Officer, at (301) 443–3983. 

SUPPLEMENTARY INFORMATION: When 

submitting comments or requesting 

information, please include the 

information request collection title for 

reference. 

Information Collection Request Title: 

Maternal Health Portfolio Evaluation 

Design OMB No. 0906–0059—Revision. 

Abstract: HRSA programs provide 

health care to people who are 

geographically isolated, economically, 

or medically vulnerable. HRSA 

programs help those in need of high 

quality primary health care, such as 

pregnant women and mothers. 

Improving maternal health outcomes 

and access to quality maternity care 

services is a key component of the 

HRSA mission. HRSA’s Maternal and 

Child Health Bureau provides funding 

to address some of the most urgent 

issues influencing the high rates of 

maternal mortality. With this emphasis 

on improving maternal health across the 

life course and promoting optimal 

health for all mothers, HRSA is 

employing a multipronged strategy to 

address maternal mortality and severe 

maternal morbidity through the 

following programs: 

1. The State Maternal Health 

Innovation Program, 

2. The Alliance for Innovation on 

Maternal Health Program, 

3. The Alliance for Innovation on 

Maternal Health—Community Care 

Initiative, 

4. The Rural Maternity and Obstetrics 

Management Strategies Program, and 

5. The Supporting Maternal Health 

Innovation Program. 

HRSA is conducting a portfolio-wide 

evaluation of HRSA-supported Maternal 

Health Programs with a primary focus 

on reducing maternal mortality. 

Through this evaluation, HRSA seeks to 

identify individual and/or collective 

strategies, interrelated activities, and 

common themes within and across the 

Maternal Health Programs that may be 

contributing to or driving improvements 

in key maternal health outcomes. HRSA 

seeks to ascertain which components 

should be elevated and replicated to the 

national level, as well as inform future 

investments to reduce rates of maternal 

mortality and severe maternal 

morbidity. 

Need and Proposed Use of the 

Information: HRSA seeks to understand 

the impact of HRSA’s investments into 

maternal health programs. These five 

HRSA maternal health programs 

represent a total of 12 state-based 

grantees and three grantees with the 

potential for national reach. In 

understanding the strategies that are 

most effective in reducing maternal 

morbidity and mortality, HRSA will be 

able to determine which program 

elements could be replicated and/or 

scaled up nationally. 

Likely Respondents: Likely 

respondents are recipients of the 

cooperative agreements mentioned 

above (State Maternal Health Innovation 

Program, Alliance for Innovation on 

Maternal Health Program, Alliance for 

Innovation on Maternal Health— 

Community Care Initiative, and 

Supporting Maternal Health Innovation 

Program) which include state health 

agencies, national organizations, and 

academic organizations. 

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 


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