Information Collection

Add Program and Add User - State Sealant Administrator

IC 238597 under ICR 202309-0920-005 · OMB 0920-1289.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-1289

Is this a Common Form? No

IC Status: Modified

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.