Information Collection

Ryan White HIV/AIDS Program Dental Services Report.

IC 6384 under ICR 201403-0915-006 · OMB 0915-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0151 can be found here:

Documents and Forms

Document Name Document Type
C- 2015 DSR Instructions.docx Instruction
1 Ryan White HIV/AIDS Program Dental Services Report B - 2015 DSR Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ryan White HIV/AIDS Program Dental Services Report.	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
Instruction			C- 2015 DSR Instructions.docx		Yes	Yes	Printable Only
Form	1	Ryan White HIV/AIDS Program Dental Services Report	B - 2015 DSR Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 68	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	68	-2	70
Annual IC Time Burden (Hours)	2,940	1,540	1,400
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.