Information Collection

Email Invite Fluoride Testing data

IC 239186 under ICR 202001-0920-003 · OMB 0920-1319.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1319 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-19DO Email Invite Fluoride Testing data	Form and Instruction
0920-19DO Email Invitation for fluoride testing data submission 19DO Att. 2c Email Invite Fluoride Testing Final.docx	Form and Instruction

IC Title:

Email Invite Fluoride Testing data

Agency IC Tracking Number:

0920-19DO

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	0920-19DO	Email Invitation for fluoride testing data submission	19DO Att. 2c Email Invite Fluoride Testing Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 33

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	908	908
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.