Information Collection

[PHIC] State Dental Director and Key Oral Health Program Staff Survey (2025)

IC 274484 under ICR 202410-0920-015 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State Dental Director and Key Oral Health Program Staff Survey [PHIC] State Dental Director and Key Oral Health Program Staff Survey (2025)	Form and Instruction
State Dental Director and Key Oral Health Program Staff Att A. Online Svy Wrd Version March 2025.docx	Form and Instruction
SSA_STLT_DOH_03052025_final.docx SSA	IC Document
SSB_STLT_DOH_03052025.docx SSB	IC Document
Att B. Online Survey_Web Version.docx Online Survey Web Version	IC Document
Att C. Pre-Invitation Email.docx Pre-Invitation Email	IC Document
Att D. Invitation Email_2025.docx Invitation Email	IC Document
Att E. Reminder Email One Week_2025.docx Reminder Email One Week	IC Document
Att F. Reminder Email Two Days_2025.docx Reminder Email Two Days	IC Document
Att G. Reminder Email Deadline Extension.docx Reminder Email Deadline Extension	IC Document
Att H. State Respondents_Mar_2025.docx State Respondents	IC Document
Att I. CDC Project Determination.docx Research Determination	IC Document
Att J. Comparison of Past and Current Questions.xlsx Comparison of Past and Current Questions	IC Document

IC Title:

[PHIC] State Dental Director and Key Oral Health Program Staff Survey (2025)

Agency IC Tracking Number:

0920-25-0051

IC Status: New

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	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19	19
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
SSA		03/20/2025
SSB		03/20/2025
Online Survey Web Version		03/20/2025
Pre-Invitation Email		03/20/2025
Invitation Email		03/20/2025
Reminder Email One Week		03/20/2025
Reminder Email Two Days		03/20/2025
Reminder Email Deadline Extension		03/20/2025
State Respondents		03/20/2025
Research Determination		03/20/2025
Comparison of Past and Current Questions		03/20/2025

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

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