Ryan White HIV/AIDS Program Part F Dental Services Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form B Ryan White HIV/AIDS Program Dental Services Report.	Form	Modified	Available
E - Respondents on Burden Estimates in Completing the DSR Form.docx	Supplementary Document	Uploaded 2017-05-16	Available
D - 60-day FRN_09015-0151.pdf	Supplementary Document	Uploaded 2017-05-16	Available
Supporting Statement_DSR_2017_5-10-17.docx	Supporting Statement A	Uploaded 2017-05-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6384	Ryan White HIV/AIDS Program Dental Services Report.	Form	Modified

ICR Details

OMB Control No: 0915-0151	ICR Reference No: 201705-0915-003
Status: Historical Active	Previous ICR Reference No: 201403-0915-006
Agency/Subagency: HHS/HSA	Agency Tracking No: 21572
Title: Ryan White HIV/AIDS Program Part F Dental Services Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/26/2017
	Date Received in OIRA: 05/18/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	68	0	68
Time Burden (Hours)	2,940	0	2,940
Cost Burden (Dollars)	0	0	0

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Abstract: The Dental Reimbursement Program (DRP) and the Community-Based Dental Partnership Program (CBDPP) serve to expand the availability of oral health care to patients with HIV/AIDS through the training of dental professionals. The DRP reimburses dental education programs for uncompensated funds to provide oral health services. The CBDPP funds entities in their efforts to increase access to oral health care.

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Authorizing Statute(s): PL: Pub.L. 111 - 87 2 Name of Law: Ryan White HIV/AIDS Treatment Extension Act of 2009
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 6581	01/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 22837	05/18/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Ryan White HIV/AIDS Program Dental Services Report.	B	B - 2017 DSR Form.docx

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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	68	68	0	0	0	0
Annual Time Burden (Hours)	2,940	2,940	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $255,174

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 05/18/2017

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