Oral Health Basic Screening Survey for Children

Documents and Forms

Document Name Document Type
Form 0920-20PM Oral Health Basic Screening Survey for Children Form and Instruction
0920-20PM Data Submission form 2i_data form submitted by states.docx Form and Instruction
0920-20PM Data Submission form 2i_data form submitted by states.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Oral Health Basic Screening Survey for Children	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20PM	Data Submission form	2i_data form submitted by states.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	18,554	18,554
Annual IC Cost Burden (Dollars)	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.