Crosswalk of Form Changes

Health Resources and Services Administration

Maternal and Child Health Bureau

Discretionary Grant Performance Measures

OMB No. 0915-0298

Expires: _________

Attachment B-1

Crosswalk of Proposed to Prior
Performance Measures

OMB Clearance Package

	DGIS Performance Measure Crosswalk to prior DGIS OMB Package
Performance Measure	Measure Status	Supporting Text Status	Prior PM Name (if applicable)	Topic	Data Source
Core 1	Removed since prior OMB approved package			Grant Impact	N/A
Core 3	Revised in 2022, included in prior OMB approved package			Health Equity – MCH Outcomes	Grantee self-report
CB 1	Included in 2022, no changes from prior OMB approved package			State Capacity for Advancing the Health of MCH Populations	Grantee self-report
CB 2	Removed since prior OMB approved package			Technical Assistance	N/A
CB 3	Included in 2022, no changes from prior OMB approved package		CB 3	Impact Measurement	Grantee self-report
CB 4	Included in 2022, no changes from prior OMB approved package		CB 4	Sustainability	Grantee self-report
CB 5	Included in 2022, no changes from prior OMB approved package			Scientific Publications	Grantee self-report
CB 6	Included in 2022, no changes from prior OMB approved package			Products	Grantee self-report
CB 7	Removed since prior OMB approved package			Direct Annual Access to MCH Data	N/A
CB 8	Included in 2023, moved from Core to Capacity Building.		Core 2	Quality Improvement	Grantee self-report
WMH 1	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Prenatal Care	Grantee self-report or HS Data Collection
WMH 2	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Perinatal/ Postpartum Care	Grantee self-report or HS Data Collection
WMH 3	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Well Woman Visit/ Preventive Health Care	Grantee self-report or HS Data Collection
WMH 4	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Depression Screening	Grantee self-report or HS Data Collection
PIH 1	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Safe Sleep	Grantee self-report or HS Data Collection
PIH 2	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Breast Feeding	Grantee self-report or HS Data Collection
PIH 3	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Newborn Screening	Grantee self-report or HS Data Collection
CH 1	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Well Child Visit	Grantee self-report or HS Data Collection
CH 2	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Quality of Well Child Visit	Grantee self-report
CH 3	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Developmental Screening	Grantee self-report or HS Data Collection
CH 4	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Injury Prevention	Grantee self-report
CSHCN 1	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Family Engagement	Grantee self-report
CSHCN 2	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Access to and Use of Medical Home	Grantee self-report
CSHCN 3	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Transition to Adult Health Care	Grantee self-report
AH 1	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Adolescent Well Visit	Grantee self-report
AH 2	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Injury Prevention	Grantee self-report
AH 3	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Screening for Major Depressive Disorder	Grantee self-report
LC 1	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Adequate Health Insurance Coverage	Grantee self-report or HS Data Collection
LC 2	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Tobacco and eCigarette Cessation	Grantee self-report or HS Data Collection
LC 3	Included in 2022, no changes from prior OMB approved package	Updated Benchmark Data Sources, Grantee Data Sources, and Significance		Oral Health	Grantee self-report
Training 01	Included in 2022, no changes from prior OMB approved package	Updated Significance		MCH Training Program and Healthy Tomorrows Family Member/ Youth/ Community Member participation	Grantee self-report
Training 02	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		MCH Training Program and Healthy Tomorrows Cultural Competence	Grantee self-report
Training 03	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Healthy Tomorrows Title V Collaboration	Grantee self-report
Training 04	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Title V Collaboration	Grantee self-report
Training 05	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Policy	Grantee self-report
Training 06	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Diversity of Long-Term Trainees	Grantee self-report
Training 07	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		MCH Pipeline Program – Work with MCH populations	Grantee self-report
Training 08	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		MCH Pipeline Program – Work with underserved or vulnerable populations	Grantee self-report
Training 09	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		MCH Pipeline - Graduate Program Enrollment	Grantee self-report
Training 10	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Leadership	Grantee self-report
Training 11	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Work with MCH Populations	Grantee self-report
Training 12	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Interdisciplinary Practice	Grantee self-report
Training 13	Removed since prior OMB approved package			Diverse Adolescent Involvement (LEAH-specific)	Grantee self-report
Training 14	Included in 2022, no changes from prior OMB approved package	Updated terminology, Benchmark Data Sources, and Significance		Medium-Term Trainees Skill and Knowledge (PPC-Specific)	Grantee self-report
Training 15	New in 2022 Package			Consultation and Training for Mental and Behavioral Health	Grantee self-report
EMSC 01	Included in 2022, no changes from prior OMB approved package	Updated Goal		Using NEMSIS Data to Identify Pediatric Patient Care Needs.	Grantee self-report
EMSC 02	Included in 2022, no changes from prior OMB approved package	Updated Goal		Pediatric Emergency Care Coordination	Grantee self-report
EMSC 03	Included in 2022, no changes from prior OMB approved package	Updated Goal		Use of pediatric-specific equipment	Grantee self-report
EMSC 04	Included in 2022, no changes from prior OMB approved package	Updated Goal		Pediatric medical emergencies	Grantee self-report
EMSC 05	Included in 2022, no changes from prior OMB approved package	Updated Goal		Pediatric traumatic emergencies	Grantee self-report
EMSC 06	Included in 2022, no changes from prior OMB approved package	Updated Goal		Written inter-facility transfer guidelines that contain all the components as per the implementation manual.	Grantee self-report
EMSC 07	Included in 2022, no changes from prior OMB approved package	Updated Goal		Written inter-facility transfer agreements that covers pediatric patients.	Grantee self-report
EMSC 08	Included in 2022, no changes from prior OMB approved package	Updated Goal		Established permanence of EMSC	Grantee self-report
EMSC 09	Included in 2022, no changes from prior OMB approved package	Updated Goal		Established permanence of EMSC by integrating EMSC priorities into statutes/regulations.	Grantee self-report
HS 01	Included in 2022, no changes from prior OMB approved package	Updated Significance		Reproductive Life Plan	Grantee self-report or HS Data Collection
HS 02	Included in 2022, no changes from prior OMB approved package			Usual Source of Care	Grantee self-report or HS Data Collection
HS 03	Included in 2022, no changes from prior OMB approved package	Updated Significance		Interconception Planning	Grantee self-report or HS Data Collection
HS 04	Included in 2022, no changes from prior OMB approved package	Updated Significance		Intimate Partner Violence Screening	Grantee self-report or HS Data Collection
HS 05	Included in 2022, no changes from prior OMB approved package	Updated Significance		Father/ Partner Involvement during Pregnancy	Grantee self-report or HS Data Collection
HS 06	Included in 2022, no changes from prior OMB approved package			Father and/or Partner Involvement with Child 0-24 Months	Grantee self-report or HS Data Collection
HS 07	Included in 2022, no changes from prior OMB approved package			Daily Reading	Grantee self-report or HS Data Collection
HS 08	Included in 2022, no changes from prior OMB approved package			CAN implementation	Grantee self-report or HS Data Collection
HS 09	Included in 2022, no changes from prior OMB approved package			CAN Participation	Grantee self-report or HS Data Collection
F2F 1	Revised in 2022, included in prior OMB approved package			Provide National Leadership for families with children with special health needs	Grantee self-report
Form 1	Revised in 2022, included in prior OMB approved package			MCHB Project Budget Details For FY____	Grantee self-report
Form 2	Removed since prior OMB approved package			Project Funding Profile	Grantee self-report
Form 3	Revised in 2022, included in prior OMB approved package			Budget Details by Types of Individuals Served	Grantee self-report
Form 4	Removed since prior OMB approved package			Project Budget and Expenditures - revisions combine Population-Based Services and Infrastructure Building Services into Public Health Services and Systems	Grantee self-report
Form 5	Revised in 2022, included in prior OMB approved package			Number of Individuals Served (unduplicated)	Grantee self-report
Form 6	Revised in 2022, included in prior OMB approved package			Maternal & Child Health Discretionary Grant Project Abstract for FY ______	Grantee self-report
Form 7	Included in 2022, no changes from prior OMB approved package			Discretionary Grant Project Summary Data and Demographics	Grantee self-report
Form 8	Included in 2022, no changes from prior OMB approved package			MCH Discretionary Grant Project Abstract for FY (For Research Projects ONLY)	Grantee self-report
Technical Assistance/ Collaboration Form	Included in 2022, no changes from prior OMB approved package	Updated instructions		Technical Assistance/Collaboration refers to mutual problem solving and collaboration on a range of issues, which may include program development, clinical services, collaboration, program evaluation, needs assessment, and policy & guidelines formulation.	Based on information reported in Domain measures.
Products, Publications and Submissions Data Collection Form	Included in 2022, no changes from prior OMB approved package		N/A	List of products, publications and submissions addressing maternal and child health that have been published or produced with grant support (either fully or partially) during the reporting period.	Based on information reported in Domain measures.
MCH Training Program Data Forms	Revised in 2022, included in prior OMB approved package		N/A	List of all personnel (faculty, staff, and others) contributing to MCH training project