Information Collection

Instructions to Update the Fluoridation Status and Population Data

IC 239185 under ICR 202312-0920-006 · OMB 0920-1319.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1319 Instructions to Update the Fluoridation Status and Population Data	Form and Instruction
0920-1319 Instructions to Update the Fluoridation Status and Popul 19DO Att. 2a Fluoridation Status Instructions Final.docx	Form and Instruction
0920-1319 Instructions to Update the Fluoridation Status and Popul 19DO Att. 2a Fluoridation Status Instructions Final.docx	Form and Instruction
0920-1319 Water Fluoridation Reporting System (WFRS) – Data Entry 1319 Att 2a Screenshots.docx	Form
0920-1319 Water Fluoridation Reporting System (WFRS) – Data Entry 1319 Att 2a Screenshots.docx	Form
1319 Att 2b fluoridation status Pop Data Wrksht.xlsx Email Invitation to States to Provide Floridation Status and Corresponding Population	IC Document
1319 Att 2b fluoridation status Pop Data Wrksht.xlsx Email Invitation to States to Provide Floridation Status and Corresponding Population	IC Document

IC Title:

Agency IC Tracking Number:

0920-1319

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	0920-1319	Instructions to Update the Fluoridation Status and Population Data	19DO Att. 2a Fluoridation Status Instructions Final.docx		Yes	Yes	Fillable Fileable
Form	0920-1319	Water Fluoridation Reporting System (WFRS) â Data Entry Screenshots from System	1319 Att 2a Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	1,875	1,875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Invitation to States to Provide Floridation Status and Corresponding Population	1319 Att 2b fluoridation status Pop Data Wrksht.xlsx	12/28/2023

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