Instructions to Update the Fluoridation Status and Population Data

[NCCDPHP] National Surveillance of Community Water Systems and Corresponding Populations with the Recommended Fluoridation Level

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Instructions to Update the Fluoridation Status and Population Data	Agency IC Tracking Number:	0920-1319

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	0920-1319	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) – 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 %

	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

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.