2025-01150. Agency Information Collection Activities: Submission to OMB for Review and Approval; Public Comment Request; Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program

Total Estimated Annualized Burden Hours

Type of respondent	Form name	Number of respondents	Number of responses per respondent	Total responses	Average burden per response (in hours)	Burden hours per form	Total burden hours
Adults—Puerto Rico	Screener Core	5,205 1,250	1 1	5,205 1,250	0.03 0.75	156.15 937.50	1,093.65
Adults—U.S. Virgin Islands	Screener Core	1,457 350	1 1	1,457 350	0.03 0.70	43.71 245	288.71
Adults—Guam	Screener Core	1,334 450	1 1	1,334 450	0.03 0.66	40.02 297	337.02
Adults—American Samoa	Screener Core	564 450	1 1	564 450	0.03 0.73	16.92 328.50	345.42
Adults—Federated States of Micronesia	Screener Core	625 450	1 1	625 450	0.03 0.68	18.75 306.00	324.75
Adults—Republic of the Marshall Islands	Screener Core	360 300	1 1	360 300	0.03 0.65	10.80 195.00	205.80
Adults—Commonwealth of the Northern Mariana Islands	Screener Core	670 500	1 1	670 500	0.03 0.75	20.10 375	395.10
Adults—Republic of Palau	Screener Core	285 250	1 1	285 250	0.03 0.70	8.55 175	183.55
Total	Screener Core	10,500 4,000	1 1	10,500 4,000	0.03 0.71	315.00 2,840.00	2  3,155