Information Collection

Add Program and Add User - State Sealant Administrator

IC 238597 under ICR 201910-0920-011 · OMB 0920-1289.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1289 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Add Program and Add User - State Sealant Administrator	Form and Instruction
Add Program and Add User SEALS Att 2c Entry Form & Manual SS Final.docx	Form and Instruction

IC Title:

Add Program and Add User - State Sealant Administrator

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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 and Instruction	NA	Add Program and Add User	SEALS Att 2c Entry Form & Manual SS Final.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	5	5
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.