[NCCDPHP] Oral Health Basic Screening Survey for Children

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Data Submission form	Form and Instruction	Modified	Available
Oral Health Basic Screening Survey for Children	Form and Instruction	Modified	Repair queued
School Participation Form	Form and Instruction	Modified	Available
School Participation Form	Form and Instruction	Modified	Repair queued
Screening Form	Form and Instruction	Modified	Available
Child Screening Form	Form and Instruction	Modified	Repair queued
Consent Form	Form and Instruction	Modified	Available
Consent Form	Form and Instruction	Modified	Repair queued
Screening Form	Form and Instruction	Modified	Available
Screener Screening Form	Form and Instruction	Modified	Repair queued
video-basic-screening-survey-for-non-dental-professionals.m4v	Supplementary Document	Uploaded 2024-08-28	Repair queued
video-basic-screening-survey-for-non-dental-professionals.m4v	Supplementary Document	Uploaded 2024-08-28	Repair queued
5_ASTDD sample screening budget.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
5_ASTDD sample screening budget.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
4_IRB exemption.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
4_IRB exemption.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
3a_60-day FRN full text.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
3a_60-day FRN full text.pdf	Supplementary Document	Uploaded 2024-08-28	Available
2h_request and reminder email to states for data.docx	Supplementary Document	Uploaded 2024-08-28	Available
2h_request and reminder email to states for data.docx	Supplementary Document	Uploaded 2024-08-28	Available
2g_notice of screening results.docx	Supplementary Document	Uploaded 2024-08-28	Repair queued
2g_notice of screening results.docx	Supplementary Document	Uploaded 2024-08-28	Repair queued
2c_guidance on data analysis.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
2c_guidance on data analysis.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
2b_guidance on sampling design.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
2b_guidance on sampling design.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
2abc_link to video that accompanies manual.docx	Supplementary Document	Uploaded 2024-08-28	Repair queued
2abc_link to video that accompanies manual.docx	Supplementary Document	Uploaded 2024-08-28	Repair queued
2a_Children BSS manual_clean.docx	Supplementary Document	Uploaded 2024-08-28	Repair queued
2a_Children BSS manual_clean.docx	Supplementary Document	Uploaded 2024-08-28	Repair queued
1_Authorizing Legislation.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
1_Authorizing Legislation.pdf	Supplementary Document	Uploaded 2024-08-28	Repair queued
support-statement-B_final.docx	Supporting Statement B	Uploaded 2024-08-19	Repair queued
support-statement-B_final.docx	Supporting Statement B	Uploaded 2024-08-19	Repair queued
support-statement-A-508_final.docx	Supporting Statement A	Uploaded 2024-11-26	Repair queued
support-statement-A-508_final.docx	Supporting Statement A	Uploaded 2024-08-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
245500	Oral Health Basic Screening Survey for Children	Form and Instruction	Modified	Data Submission form
245500	Oral Health Basic Screening Survey for Children	Form and Instruction	Modified
245499	School Participation Form	Form and Instruction	Modified	School Participation Form
245499	School Participation Form	Form and Instruction	Modified
245498	Child Screening Form	Form and Instruction	Modified	Screening Form
245498	Child Screening Form	Form and Instruction	Modified
245497	Consent Form	Form and Instruction	Modified	Consent Form
245497	Consent Form	Form and Instruction	Modified
245496	Screener Screening Form	Form and Instruction	Modified	Screening Form
245496	Screener Screening Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1346	ICR Reference No: 202408-0920-007
Status: Active	Previous ICR Reference No: 202102-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1346
Title: [NCCDPHP] Oral Health Basic Screening Survey for Children
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/26/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/29/2024
Terms of Clearance: Approved consistent with the understanding that in the next revision/extension of the package, CDC will update this information collect to use detailed race/ethnicity question (SPD 15, Figure 1, March 28, 2024) or CDC will provide further/additional justification in Supporting Statement A why it cannot use the detailed question.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved	11/30/2024
Responses	303,965	0	303,965
Time Burden (Hours)	40,207	0	40,207
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC collects state-level prevalence of dental caries and sealants among children from state oral health programs and publishes on CDC's public-facing website to 1) facilitate state oral health surveillance capacity to monitor oral health status, trends, and disparities, and to compare with other states; 2) inform planning and evaluation of oral health programs and policies; 3) measure progress toward the Healthy People objectives; and 4) educate the public and policy makers regarding cross-cutting public health programs. CDC also uses the data to evaluate performance of CDC oral health funding recipients.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 2617	01/16/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 66724	08/16/2024
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Child Screening Form	n/a	Screening Form
Consent Form	n/a	Consent Form
Oral Health Basic Screening Survey for Children	n/a	Data Submission form
School Participation Form	n/a	School Participation Form
Screener Screening Form	n/a	Screening Form

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	303,965	303,965	0	0	0	0
Annual Time Burden (Hours)	40,207	40,207	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $42,233

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  Yes

Description/Changes for Common Form Usage:  This collection does not use a Common Form. It was errantly entered that way last submission.

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/29/2024

---