2024-25246. Agency Information Collection Activities: Proposed Collection: Public Comment Request; Information Collection Request Title: Maternal and Child Health Jurisdictional Survey Instrument for the Title V Maternal and Child Health Block Grant ...

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 2
Adults—Puerto Rico	Screener	5,205	1	5,205	0.03	156.15	1,093.65
	Core	1,250	1	1,250	0.75	937.50
Adults—U.S. Virgin Islands	Screener	1,457	1	1,457	0.03	43.71	288.71
	Core	350	1	350	0.70	245
Adults—Guam	Screener	1,334	1	1,334	0.03	40.02	337.02
	Core	450	1	450	0.66	297
Adults—American Samoa	Screener	564	1	564	0.03	16.92	345.42
	Core	450	1	450	0.73	328.50
Adults—Federated States of Micronesia	Screener	625	1	625	0.03	18.75	324.75
	Core	450	1	450	0.68	306.00
Adults—Republic of the Marshall Islands	Screener	360	1	360	0.03	10.80	205.80
	Core	300	1	300	0.65	195.00
Adults—Common-wealth 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	285	1	285	0.03	8.55	183.55
	Core	250	1	250	0.70	175
Total	Screener	10,500	1	10,500	0.03	315.00	3,155
	Core	4,000	1	4,000	0.71	2,840.00