[Federal Register Volume 88, Number 7 (Wednesday, January 11, 2023)]
[Notices]
[Pages 1580-1582]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-00334]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[60Day-23-1294; Docket No. CDC-2022-0143]


Proposed Data Collection Submitted for Public Comment and 
Recommendations

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Notice with comment period.

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SUMMARY: The Centers for Disease Control and Prevention (CDC), as part 
of its continuing effort to reduce public burden and maximize the 
utility of government information, invites the general public and other 
federal agencies the opportunity to comment on a continuing information 
collection, as required by the Paperwork Reduction Act of 1995. This 
notice invites comment on a proposed information collection project 
titled Maternal Mortality Review Information Application (MMRIA). MMRIA 
is a standardized data collection system that allows Maternal Mortality 
Review Committees (MMRCs) to abstract relevant data from a variety of 
sources, document committee decisions, and analyze data to better 
understand the contributing factors and preventability of pregnancy-
related deaths in order to develop recommendations for prevention.

DATES: CDC must receive written comments on or before March 13, 2023.

ADDRESSES: You may submit comments, identified by Docket No. CDC-2022-
0143 by either of the following methods:
     Federal eRulemaking Portal: www.regulations.gov. Follow 
the instructions for submitting comments.
     Mail: Jeffrey M. Zirger, Information Collection Review 
Office, Centers for Disease Control and Prevention, 1600 Clifton Road 
NE, MS H21-8, Atlanta, Georgia 30329.
    Instructions: All submissions received must include the agency name 
and Docket Number. CDC will post, without change, all relevant comments 
to www.regulations.gov.
    Please note: Submit all comments through the Federal eRulemaking 
portal (www.regulations.gov) or by U.S. mail to the address listed 
above.

FOR FURTHER INFORMATION CONTACT: To request more information on the 
proposed project or to obtain a copy of the information collection plan 
and instruments, contact Jeffrey M. Zirger, Information Collection 
Review Office, Centers for Disease Control and Prevention, 1600 Clifton 
Road NE, MS H21-8, Atlanta, Georgia 30329; Telephone: 404-639-7118; 
Email: [email protected].

SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from 
the Office of Management and Budget (OMB) for each collection of 
information they conduct or sponsor. In addition, the PRA also requires 
federal agencies to provide a 60-day notice in the Federal Register 
concerning each proposed collection of information, including each new 
proposed collection, each proposed extension of existing collection of 
information, and each reinstatement of previously approved information 
collection before submitting the collection to the OMB for approval. To 
comply with this requirement, we are publishing this notice of a 
proposed data collection as described below.
    The OMB is particularly interested in comments that will help:
    1. Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
    2. Evaluate the accuracy of the agency's estimate of the burden of 
the proposed collection of information, including the validity of the 
methodology and assumptions used;
    3. Enhance the quality, utility, and clarity of the information to 
be collected;
    4. Minimize the burden of the collection of information on those 
who are to respond, including through the use of appropriate automated, 
electronic, mechanical, or other technological collection techniques or 
other forms of information technology, e.g., permitting electronic 
submissions of responses; and
    5. Assess information collection costs.

[[Page 1581]]

Proposed Project

    The Maternal Mortality Review Information Application (MMRIA) (OMB 
Control No. 0920-1294, Exp. 04/30/2023)--Revision--National Center for 
Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for 
Disease Control and Prevention (CDC).

Background and Brief Description

    The Centers for Disease Control and Prevention (CDC) seeks a 
Revision to continue to collect information through the Maternal 
Mortality Review Information Application (MMRIA) for three more years. 
MMRIA is a standardized data collection system that allows Maternal 
Mortality Review Committees (MMRCs) across the country to abstract 
relevant data (clinical and non-clinical) from a variety of sources, 
document committee decisions, and analyze data in order to better 
understand the contributing factors and preventability of pregnancy-
related deaths and thus to develop recommendations for prevention.
    Pregnancy-related deaths are defined as a death as a result of 
pregnancy or delivery complications, a chain of events initiated by 
pregnancy, or the aggravation of an unrelated condition by the 
physiologic effects of pregnancy. Considerable racial disparities 
exist, with persons who are American Indian/Alaska Native and Black 
persons two to three times more likely to die from pregnancy-related 
complications than persons who are White. Findings from analyses of 
aggregated MMRC data indicate that about four out of five pregnancy-
related deaths are preventable.
    Maternal Mortality Review is a process by which a multidisciplinary 
committee at the jurisdiction level identifies and reviews cases of 
death that occur during or within one year of end of pregnancy. Members 
of MMRCs typically represent public health, obstetrics and gynecology, 
maternal-fetal medicine, nursing, midwifery, forensic pathology, mental 
and behavioral health, community-based organizations, and other 
relevant partners. Through a partnership among the MMRC, state vital 
records office, and epidemiologists, deaths among females of 
reproductive age are examined to determine if they occurred during 
pregnancy or within one year of the end of pregnancy (i.e., pregnancy-
associated deaths). Through this process, potential cases of pregnancy-
related deaths (i.e., death from any cause related to or aggravated by 
pregnancy or its management) are then identified. Review committees 
access multiple sources of clinical and non-clinical information to 
understand the circumstances surrounding a death in order to determine 
pregnancy-relatedness and develop recommendations for action to prevent 
similar deaths in the future.
    MMRIA is a standardized data collection system designed to support 
MMRC processes. Data are abstracted and entered into MMRIA from various 
sources, including death records, autopsy reports, birth and fetal 
death records, prenatal care records, emergency department visit 
records, hospitalization records, records from other medical office 
visits, medical transport records, social and environmental profiles, 
mental health profiles, and informant interviews. Case narratives for 
committee reviews are developed from the abstracted data entered into 
MMRIA to facilitate committee review, and committee decisions based on 
their review are also be entered into MMRIA. The data collected in 
MMRIA is used to facilitate an understanding of the drivers of maternal 
mortality and complications of pregnancy and associated disparities; 
determine what interventions at patient, provider, facility, system, 
and community levels will have the most impact; and implement data 
driven recommendations.
    The burden estimates presented here are applicable to the 40 
jurisdictions with funding support through the cooperative agreements 
Preventing Maternal Deaths: Supporting Maternal Mortality Review 
Committees (CDC-RFA-DP19-1908) and Preventing Maternal Mortality: 
Supporting Maternal Mortality Review Committees CDC-RFA-DP22-2211) 
which includes 39 direct awardees and one sub-awardee. These 
jurisdictions are required to compile a defined set of information 
about pregnancy-related deaths into MMRIA. It is estimated that 
information will be collected for a total of 1,983 pregnancy-associated 
deaths on average, annually, among the 40 jurisdictions with funding 
support through CDC-RFA-DP19-1908 and CDC-RFA-DP22-2211. For 23 
jurisdictions, it is estimated that on average, 15 hours of data 
abstraction are required for each death entered into MMRIA. The other 
17 jurisdictions are able to participate in a process to reduce burden 
by which CDC uploads vital records information into MMRIA rather than 
jurisdiction staff manually abstracting vital records. For these 17 
jurisdictions, the estimated average is 14 hours of abstraction for 
each death entered into MMRIA. For all jurisdictions with funding 
support through CDC-RFA-DP19-1908 and CDC-RFA-DP22-2211, an additional 
24 minutes on average is needed to enter the committee decisions into 
MMRIA.
    There are four changes that result in this request for revision, 
with the first three having an impact on the estimated burden for this 
revision. First, through additional congressional appropriations, an 
additional 15 jurisdictions are now funding recipients. This represents 
an increase from 24 to 39 funding recipients. There is a total of 40 
respondents, because one funding recipient provides a subaward to an 
additional respondent. Second, CDC estimates a higher number of 
pregnancy-associated deaths due to utilizing data from the Pregnancy 
Mortality Surveillance System (PMSS) rather than CDC WONDER for these 
estimates. PMSS estimates of pregnancy-associated deaths are more 
accurate due to more comprehensive and complete identification of these 
deaths through multiple case identification methods. Third, CDC has 
been working with the National Association for Public Health Statistics 
and Information Systems on an initiative that enables CDC to transfer 
vital records data associated with CDC identified pregnancy-associated 
deaths directly into a jurisdiction's instance of MMRIA, reducing 
manual data entry burden for the 17 respondents participating in the 
initiative. Fourth, to address user identified needs and increase data 
use for analysis by jurisdictions, a total of 60 new optional fields 
were added to MMRIA, three fields removed, and two fields combined. 
None of the added fields are required fields.
    These changes resulted in an overall increase to the estimated 
burden from the previous approval. CDC requests OMB approval for an 
estimated 29,950 annual burden hours. There is no cost to respondents 
other than their time to participate.

[[Page 1582]]



                                        Estimated Annualized Burden Hours
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                                                                                            Average
                                                              Number of      Number of     burden per    Total
         Type of respondent                 Form name        respondents   responses per    response     burden
                                                                            respondent      (in hr)     (in hr)
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Jurisdictions with funding support    MMRIA data                      23              50           15     17,250
 through CDC-RFA-DP19-1908 and CDC-    abstraction.
 RFA-DP22-2211 who manually abstract
 all data into MMRIA.
Jurisdictions with funding support    MMRIA data                      17              50           14     11,900
 through CDC-RFA-DP19-1908 and CDC-    abstraction.
 RFA-DP22-2211 for which CDC is
 uploading vital records into MMRIA
 and jurisdiction staff abstract
 remaining data manually into MMRIA.
All jurisdictions with funding        MMRIA committee                 40              50          0.4        800
 support through CDC-RFA-DP19-1908     decisions form.
 and CDC-RFA-DP22-2211.
                                                            ----------------------------------------------------
    Total...........................  .....................  ...........  ..............  ...........     29,950
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Jeffrey M. Zirger,
Lead, Information Collection Review Office, Office of Scientific 
Integrity, Office of Science, Centers for Disease Control and 
Prevention.
[FR Doc. 2023-00334 Filed 1-10-23; 8:45 am]
BILLING CODE 4163-18-P