Synopses of State Dental Public Health Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Synopses of State Dental Public Health Programs	Form and Instruction	New	Repair queued
3b. Public Submission Response.docx	Supplementary Document	Uploaded 2022-10-17	Repair queued
StateSynopsis privacy-narrative-form - signed.pdf	Supplementary Document	Uploaded 2022-10-17	Repair queued
5. Human Subjects Determination DOH CDC RFA 18-1811.pdf	Supplementary Document	Uploaded 2022-10-17	Repair queued
4. OHDPortal.png	Supplementary Document	Uploaded 2022-10-17	Repair queued
3a. 60 day FRN Synopsis State Oral Health.pdf	Supplementary Document	Uploaded 2022-10-17	Repair queued
2k. State Synopsis Burden Calculation .xlsx	Supplementary Document	Uploaded 2022-10-17	Repair queued
2j. state-synopses-webcast.pdf	Supplementary Document	Uploaded 2022-10-17	Repair queued
2i. BurdenEmail.png	Supplementary Document	Uploaded 2022-10-17	Repair queued
2h. FollowUptoUnrepsonsiveState.png	Supplementary Document	Uploaded 2022-10-17	Repair queued
2g. statereminderScreenshot (304).png	Supplementary Document	Uploaded 2022-10-17	Repair queued
2f. State Synopses Survey Burden Form.docx	Supplementary Document	Uploaded 2022-10-17	Repair queued
2e. EmailSenttoVerifyStateInfo.png	Supplementary Document	Uploaded 2022-10-17	Repair queued
2d. ZoomCallInvite+SurveyMonkeyLink.png	Supplementary Document	Uploaded 2022-10-17	Repair queued
2c. EmailSurveyAnnouncement.png	Supplementary Document	Uploaded 2022-10-17	Repair queued
1_Legislation.pdf	Supplementary Document	Uploaded 2022-10-17	Repair queued
CDC DOH_State Synopsis_SSB-508.docx	Supporting Statement B	Uploaded 2022-10-17	Repair queued
CDC DOH_State Synopsis_SSA-508_final.docx	Supporting Statement A	Uploaded 2022-10-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
256465	Synopses of State Dental Public Health Programs	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202210-0920-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22EN
Title: Synopses of State Dental Public Health Programs
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/17/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	51	0
Time Burden (Hours)	299	0
Cost Burden (Dollars)	0	0

---

Abstract: The purpose of the State Synopses is for CDC and ASTDD to obtain current information from each state annually on demographic, infrastructure, workforce, and administrative factors that impact the state’s oral health program. In addition, each state is asked to provide detailed information on the services they provide to their constituents. The State Synopsis collects demographic information on the population served, state oral health infrastructure (i.e., population served by community water fluoridation), workforce (i.e., dental hygienists in state), administration, oral health surveillance, and programs funded by state.

---

Authorizing Statute(s): US Code: 42 USC 247b-14 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 27151	05/06/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 62858	10/17/2022
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Synopses of State Dental Public Health Programs	n/a	Synopses of State Dental Public Health Programs

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	51	0	0	51	0	0
Annual Time Burden (Hours)	299	0	0	299	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a New collection.

---

Annual Cost to Federal Government: $7,287

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

---

Common Form ICR:  No

---

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: 10/17/2022

---