Information Collection

Ryan White HIV/AIDS Program Dental Services Report.

IC 6384 under ICR 202306-0915-001 · OMB 0915-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0151 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Ryan White HIV/AIDS Program Dental Services Report.	Form
Tab C - 2023 DSR Manual_02_ADA.pdf	Instruction
Tab C - 2023 DSR Manual_02_ADA.pdf	Instruction
1 DSR Proposed Changes Tab B - Dental Services Report Proposed Changes.pdf	Form
1 DSR Proposed Changes Tab B - Dental Services Report Proposed Changes.pdf	Form

IC Title:

Ryan White HIV/AIDS Program Dental Services Report.

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	1	DSR Proposed Changes	Tab B - Dental Services Report Proposed Changes.pdf		Yes	Yes	Fillable Fileable
Instruction			Tab C - 2023 DSR Manual_02_ADA.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 68

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	68	0	68
Annual IC Time Burden (Hours)	1,810	-1,178	2,988
Annual IC Cost Burden (Dollars)	0	0	0

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.