Add Program and Add User - State Sealant Administrator

[NCCDPHP] Sealant Efficiency Assessment for Locals and States (SEALS)

Documents and Forms

Document Name Document Type
Form 0920-1289 Add Program and Add User - State Sealant Administrator Form and Instruction
0920-1289 SEALS Administration - Child Aggregate Screens 2a. Data Collection Form Electronic.docx Form and Instruction
0920-1289 SEALS Administration - Child Aggregate Screens 2a. Data Collection Form Electronic.docx Form and Instruction
2b Data Collection Form Paper.docx SEAlS Administration -- Add Event - Child/Programs IC Document
2b Data Collection Form Paper.docx SEAlS Administration -- Add Event - Child/Programs IC Document

Information Collection (IC) Details

IC Title:	Add Program and Add User - State Sealant Administrator	Agency IC Tracking Number:	0920-1289

Is this a Common Form? No		IC Status: Modified

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	0920-1289	SEALS Administration - Child Aggregate Screens	2a. Data Collection Form Electronic.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SEAlS Administration -- Add Event - Child/Programs	2b Data Collection Form Paper.docx	10/13/2023

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