Information Collection

Synopses of State Dental Public Health Programs

IC 256465 under ICR 202210-0920-005 · OMB 0920-1388.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-22EN

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.