Information Collection

Ryan White HIV/AIDS Program Dental Services Report.

IC 6384 under ICR 201705-0915-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form B Ryan White HIV/AIDS Program Dental Services Report.	Form
C- 2017 DSR Instructions.docx	Instruction
B B - 2017 DSR Form.docx B - 2017 DSR Form.docx	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	B	B - 2017 DSR Form.docx	B - 2017 DSR Form.docx		Yes	Yes	Fillable Fileable
Instruction			C- 2017 DSR Instructions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	68	68
Annual IC Time Burden (Hours)	2,940	2,940
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.