Information Collection

DoDEA Form 1307 "Sure Start Medical/Dental Examination"

IC 239956 under ICR 202303-0704-006 · OMB 0704-0495.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0495 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DoD Form 1307 DoDEA Form 1307 "Sure Start Medical/Dental Examination"	Form and Instruction
DoD Form 1307 Sure Start Medical/Dental Examination DoDEA Form 1307, Sure Start Medical Dental Examination.pdf	Form and Instruction
DoD Form 1307 Sure Start Medical/Dental Examination DoDEA Form 1307, Sure Start Medical Dental Examination.pdf	Form and Instruction

IC Title:

DoDEA Form 1307 "Sure Start Medical/Dental Examination"

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	DoD Form 1307	Sure Start Medical/Dental Examination	DoDEA Form 1307, Sure Start Medical Dental Examination.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title: DoDEA 26

FR Citation: 76 FR 24001

Number of Respondents: 950

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	950	950
Annual IC Time Burden (Hours)	238	238
Annual IC Cost Burden (Dollars)	1,720	1,720

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.