Ryan White CARE Act Dental Reimbursement Program

ICR 201104-0915-002

OMB: 0915-0151

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
6384 Modified
ICR Details
0915-0151 201104-0915-002
Historical Active 200805-0915-001
HHS/HSA
Ryan White CARE Act Dental Reimbursement Program
Extension without change of a currently approved collection   No
Regular
Approved without change 06/29/2011
Retrieve Notice of Action (NOA) 04/14/2011
  Inventory as of this Action Requested Previously Approved
06/30/2014 36 Months From Approved 07/31/2011
70 0 80
1,400 0 1,600
0 0 0

Under the Ryan/White HIV/AIDS Treatment Modernization Act, accredited schools of dentistry, pre- and post-doctoral dental training programs, and dental hygiene education programs may apply for reimbursement of uncompensated costs for providing oral health care to HIV infected individuals. The Dental Services Form provides information on unreimbursed expenses and descriptions of selected program components in order to determine the reimbursement award amount and to report on provided services under the Act.

PL: Pub.L. 101 - 381 2601 Name of Law: Ryan White Comprehensive AIDS Resources Emergency (CARE) Act
   PL: Pub.L. 106 - 345 101-401 Name of Law: Ryan White CARE Act Amendments of 2000
   PL: Pub.L. 109 - 415 101-401 Name of Law: Ryan White HIV/AIDS Treatment Modernization Act of 2006
   PL: Pub.L. 111 - 87 2 Name of Law: Ryan White HIV/AIDS Treatment Extension Act of 2009
  
None

Not associated with rulemaking

  76 FR 5388 01/31/2011
76 FR 17139 03/28/2011
No

1
IC Title Form No. Form Name
Ryan White CARE Act Dental Reimbursement Program 1 dental services form

  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 70 80 0 0 -10 0
Annual Time Burden (Hours) 1,400 1,600 0 0 -200 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$195,869
No
No
No
No
No
Uncollected
Carla Haddad 301 443-0165 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/14/2011


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