CDC Oral Health Management Information System - MIS Data Collection Instrument

CDC Oral Health Management Information System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0739 can be found here:

Documents and Forms

Document Name Document Type
CDC Oral Health Management Information System - MIS Data Collection Instrument Form and Instruction
0920-05CI Attachment 5 - Proposed MIS Data Collection In 0920-05CI Attachment 5 - Proposed MIS Data Collection Instrument 1-31-2007.doc Form and Instruction

Information Collection (IC) Details

IC Title:	CDC Oral Health Management Information System - MIS Data Collection Instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	0920-05CI Attachment 5 - Proposed MIS Data Collection Instrument 1-31-2007	0920-05CI Attachment 5 - Proposed MIS Data Collection Instrument 1-31-2007.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26	0	26
Annual IC Time Burden (Hours)	286	52	234
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.