Ryan White CARE Act Dental Reimbursement Program

Ryan White CARE Act Dental Reimbursement Program

OMB: 0915-0151

IC ID: 6384

Information Collection (IC) Details

View Information Collection (IC)

Ryan White CARE Act Dental Reimbursement Program
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form dental 1 dental 0151 dental report.doc Yes Yes Fillable Fileable
Instruction 0151 instructions.doc Yes No Fillable Printable

Health Health Care Services

 

80 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 80 0 0 -45 0 125
Annual IC Time Burden (Hours) 1,600 0 0 -900 0 2,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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