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Program Administration -Child Aggregate Screens (SSP Local Administrator)
[NCCDPHP] Sealant Efficiency Assessment for Locals and States (SEALS)
OMB: 0920-1289
IC ID: 238600
OMB.report
HHS/CDC
OMB 0920-1289
ICR 202309-0920-005
IC 238600
( )
Documents and Forms
Document Name
Document Type
Form 0920-1289
Program Administration -Child Aggregate Screens (SSP Local Administrator)
Form and Instruction
0920-1289 Child Aggregate Screens - Add Event
2a. Data Collection Form Electronic.docx
Form and Instruction
0920-1289 Child Aggregate Screens - Add Event
2a. Data Collection Form Electronic.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Program Administration -Child Aggregate Screens (SSP Local 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
Child Aggregate Screens - Add Event
2a. Data Collection Form Electronic.docx
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
162
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
3,240
0
3,240
0
0
0
Annual IC Time Burden (Hours)
1,134
0
1,134
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.