CDC Oral Health Management Information System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form No number New MIS Modules: Success Stories & Environmental Assessment	Form	New	Available
CDC Oral Health Management Information System - MIS Data Collection Instrument	Form and Instruction	Modified	Available
Justification for Change.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2008-04-16	Available
Change request 04 07 08.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2008-04-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
184680	New MIS Modules: Success Stories & Environmental Assessment	Form	New
178975	CDC Oral Health Management Information System - MIS Data Collection Instrument	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0739	ICR Reference No: 200804-0920-007
Status: Historical Active	Previous ICR Reference No: 200703-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: CDC Oral Health Management Information System
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2008
	Date Received in OIRA: 04/29/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	06/30/2010	06/30/2010
Responses	30	0	26
Time Burden (Hours)	330	0	234
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC is requesting a change to the CDC Oral Health Management Information System in order to incorporate recent adjustments required under the new cooperative agreement with participating states.

---

Authorizing Statute(s): US Code: 42 USC 241(a) Name of Law: Research and Investigation in General
   US Code: 42 USC 247(b)(k)(2) Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 38647	07/07/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 6246	02/09/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
CDC Oral Health Management Information System - MIS Data Collection Instrument	None	0920-05CI Attachment 5 - Proposed MIS Data Collection Instrument 1-31-2007
New MIS Modules: Success Stories & Environmental Assessment	No number	Attachment A - New MIS Modules

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	30	26	0	4	0	0
Annual Time Burden (Hours)	330	234	0	96	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: A slight increase in burden will result from the addition of two state grantees, the addition of one new component, and an environmental assessment.

---

Annual Cost to Federal Government: $408,670

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/25/2008

---