Synopses of State Dental Public Health Programs

Documents and Forms

Document Name Document Type
Synopses of State Dental Public Health Programs Form and Instruction
Synopses of State Dental Public Health Programs 2a. Synopses Word.docx Form and Instruction
Synopses of State Dental Public Health Programs 2a. Synopses Word.docx Form and Instruction
2b. Synopses SurveyMonkey.pdf Synopses of State Dental Public Health Programs SurveyMonkey IC Document
2b. Synopses SurveyMonkey.pdf Synopses of State Dental Public Health Programs SurveyMonkey IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Synopses of State Dental Public Health Programs	Agency IC Tracking Number:	0920-22EN

Is this a Common Form? No		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	n/a	Synopses of State Dental Public Health Programs	2a. Synopses Word.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	299	299
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Synopses of State Dental Public Health Programs SurveyMonkey	2b. Synopses SurveyMonkey.pdf	10/17/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.