[Federal Register Volume 88, Number 73 (Monday, April 17, 2023)]
[Notices]
[Pages 23425-23427]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-07995]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[30Day-23-1294]


Agency Forms Undergoing Paperwork Reduction Act Review

    In accordance with the Paperwork Reduction Act of 1995, the Centers 
for Disease Control and Prevention (CDC) has submitted the information 
collection request titled ``The Maternal Mortality Review Information 
Application (MMRIA)'' to the Office of Management and Budget (OMB) for 
review and approval. CDC previously published a ``Proposed Data 
Collection Submitted for Public Comment and Recommendations'' notice on 
January 11, 2023 to obtain comments from the public and affected 
agencies. CDC received one comment related to the previous notice. This 
notice serves to allow an additional 30 days for public and affected 
agency comments.
    CDC will accept all comments for this proposed information 
collection project. The Office of Management and Budget is particularly 
interested in comments that:
    (a) 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;
    (b) Evaluate the accuracy of the agencies estimate of the burden of 
the proposed collection of information, including the validity of the 
methodology and assumptions used;
    (c) Enhance the quality, utility, and clarity of the information to 
be collected;
    (d) 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 submission of responses; and (e) Assess information 
collection costs.
    To request additional information on the proposed project or to 
obtain a copy of the information collection plan and instruments, call 
(404) 639-7570. 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 30-day Review--
Open for Public Comments'' or by using the search function. Direct 
written comments and/or suggestions regarding the items contained in 
this notice to the Attention: CDC Desk Officer, Office of Management 
and Budget, 725 17th Street NW, Washington, DC 20503 or by fax to (202) 
395-5806. Provide written comments within 30 days of notice 
publication.

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 additional 
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 non-Hispanic Native Hawaiian or Other 
Pacific Islander, non-Hispanic American Indian/Alaska Native and non-
Hispanic

[[Page 23426]]

Black persons more likely to die from pregnancy-related complications 
than persons of other race-ethnicity classifications. 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 and implement data driven recommendations.
    The burden estimates presented here are applicable to the 39 
jurisdictions with funding support (which support 40 reporting 
jurisdictions 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) and 13 remaining eligible 
jurisdictions that may apply to receive funding in FY23 (CDC-RFA-DP-23-
0066). 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 2,240 pregnancy-
associated deaths on average, annually, among the 53 jurisdictions with 
current or potential funding support through CDC-RFA-DP19-1908, CDC-
RFA-DP22-2211, and CDC-RFA-DP-23-0066. For 34 jurisdictions, it is 
estimated that on average, 15 hours of data abstraction are required 
for each death entered into MMRIA. The other 19 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 19 jurisdictions, the estimated 
average is 14 hours of abstraction for each death entered into MMRIA. 
For all jurisdictions with current or potential funding support through 
CDC-RFA-DP19-1908, CDC-RFA-DP22-2211, and CDC-RFA-DP-23-0066, 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 from the time of 
initial OMB PRA approval. An additional 13 jurisdictions are eligible 
to apply for FY 23 funding. Overall, this represents an increase from 
25 to 53 respondents. 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 19 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 into 
one. None of the added fields are required fields; 50 would only be 
relevant for specific causes of death or only when a specific type of 
record is available; the majority of new optional fields are drop down 
fields with minimal response burden.
    The changes resulted in an overall increase of 21,932 burden hours. 
CDC requests OMB approval for an estimated annual burden of 33,482 
hours. There is no cost for respondents other than their time to 
participate.

                                        Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                                                      Average
                                                                     Number of       Number of      burden per
          Type of respondents                   Form name           respondents    responses per   response  (in
                                                                                    respondent        hours)
----------------------------------------------------------------------------------------------------------------
Jurisdictions with current or potential  MMRIA abstraction form.              34              42              15
 funding support through CDC-RFA-DP19-
 1908, CDC-RFA-DP22-2211, and CDC-RFA-
 DP-23-0066 who manually abstract all
 data into MMRIA.
Jurisdictions with current or potential  MMRIA abstraction form.              19              42              14
 funding support through CDC-RFA-DP19-
 1908, CDC-RFA-DP22-2211, and CDC-RFA-
 DP-23-0066 for which CDC is uploading
 vital records into MMRIA and
 jurisdiction staff abstract remaining
 data manually into MMRIA.

[[Page 23427]]

 
All jurisdictions with current or        MMRIA committee                      53              42           24/60
 potential funding support through CDC-   decision form.
 RFA-DP19-1908, CDC-RFA-DP22-2211, and
 CDC-RFA-DP-23-0066.
----------------------------------------------------------------------------------------------------------------


Jeffrey M. Zirger,
Lead, Information Collection Review Office, Office of Scientific 
Integrity, Office of Science, Centers for Disease Control and 
Prevention.
[FR Doc. 2023-07995 Filed 4-14-23; 8:45 am]
BILLING CODE 4163-18-P