Ryan White HIV/AIDS Program Part F Dental Services Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Dental Reimbursement Program (DRP) Form	Form	Modified	Available
Form 1 Dental Reimbursement Program (DRP) Form	Form	Modified	Available
Form 2 Community Based Dental Partnership (CBDPP)	Form	New	Available
Form 2 Community Based Dental Partnership (CBDPP)	Form	New	Available
Form 1 Dental Reimbursement Program (DRP) Form	Form	New	Available
Form 1 Dental Reimbursement Program (DRP) Form	Form	New	Available
Form 2 Community Based Dental Partnership Program (CBDPP)	Form	New	Available
Form 2 Community Based Dental Partnership Program (CBDPP)	Form	New	Available
Supporting Statement 0915-0151 DSR 02272026.docx	Supporting Statement A	Uploaded 2026-02-27	Available
Supporting Statement 0915-0151 DSR 02272026.docx	Supporting Statement A	Uploaded 2026-02-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6384	Ryan White HIV/AIDS Program Dental Services Report.(State/Local/Tribal)	Form	Modified	Dental Reimbursement Program (DRP) Form
6384	Ryan White HIV/AIDS Program Dental Services Report.(State/Local/Tribal)	Form	Modified	Dental Reimbursement Program (DRP) Form
6384	Ryan White HIV/AIDS Program Dental Services Report.(State/Local/Tribal)	Form	Modified
279261	Community Based Dental Partnership Program (Private)	Form	New	Community Based Dental Partnership (CBDPP)
279261	Community Based Dental Partnership Program (Private)	Form	New	Community Based Dental Partnership (CBDPP)
279261	Community Based Dental Partnership Program (Private)	Form	New
279260	Ryan White HIV/AIDS Program Dental Services Report.(Private)	Form	New	Dental Reimbursement Program (DRP) Form
279260	Ryan White HIV/AIDS Program Dental Services Report.(Private)	Form	New	Dental Reimbursement Program (DRP) Form
279260	Ryan White HIV/AIDS Program Dental Services Report.(Private)	Form	New
279254	Community Based Dental Partnership Program (State/Local/Tribal)	Form	New	Community Based Dental Partnership Program (CBDPP)
279254	Community Based Dental Partnership Program (State/Local/Tribal)	Form	New	Community Based Dental Partnership Program (CBDPP)
279254	Community Based Dental Partnership Program (State/Local/Tribal)	Form	New

ICR Details

OMB Control No: 0915-0151	ICR Reference No: 202602-0915-001
Status: Active	Previous ICR Reference No: 202306-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No: 21572
Title: Ryan White HIV/AIDS Program Part F Dental Services Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/15/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/02/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2029	36 Months From Approved	08/31/2026
Responses	68	0	68
Time Burden (Hours)	1,811	0	1,810
Cost Burden (Dollars)	0	0	0

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Abstract: The Dental Reimbursement Program (DRP) and the Community Based Dental Partnership Program (CBDPP) under Part F of the Ryan White HIV/AIDS Program (RWHAP) offer funding to accredited dental education programs to support the education and training of oral health providers in HIV oral health care and reimbursement for the provision of oral health services for people eligible for the RWHAP. Institutions eligible for the RWHAP DRP and CBDPP are accredited schools of dentistry and other accredited dental education programs, such as dental hygiene programs or those sponsored by a school of dentistry, a hospital, or a public or private institution that offers postdoctoral training in the specialties of dentistry, advanced education in general dentistry, or a dental general practice residency. The RWHAP DRP Application for the Notice of Funding Opportunity includes the Dental Services Report (DSR) that applicants use to apply for funding of non-reimbursed costs incurred in providing oral health care to patients with HIV and to report annual program data. The form is also used by CBDPP recipients to report on services rendered, patients served, and partnerships as an annual data report. The DSR collects data on program information, client demographics, oral health services, funding, and training. It also requests applicants to provide narrative descriptions of their services and facilities, as well as their linkages and how they collaborate with community-based providers of oral health services.

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Authorizing Statute(s): PL: Pub.L. 111 - 87 2 Name of Law: Ryan White HIV/AIDS Treatment Extension Act of 2009
   US Code: 42 USC 300ff-111(b) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 54333	11/26/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 9872	02/27/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Community Based Dental Partnership Program (Private)	2	Community Based Dental Partnership (CBDPP)
Community Based Dental Partnership Program (State/Local/Tribal)	2	Community Based Dental Partnership Program (CBDPP)
Ryan White HIV/AIDS Program Dental Services Report.(Private)	1	Dental Reimbursement Program (DRP) Form
Ryan White HIV/AIDS Program Dental Services Report.(State/Local/Tribal)	1	Dental Reimbursement Program (DRP) Form

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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	68	68	0	-68	68	0
Annual Time Burden (Hours)	1,811	1,810	0	-1,809	1,810	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The 1 hour increase in burden hours is due to rounding. Because applicants/recipients are both state/local/tribal entities and private sector organizations, we had separate ICs with the estimated breakdown of hours between the two awards. Furthermore, in the previous version we had one IC that encompassed DRP and CBDPP. In this version, we have ICs for DRP and CBDPP for clarity.

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Annual Cost to Federal Government: $120,855

Does this IC contain surveys, censuses, or employ statistical methods? No

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

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Common Form ICR:  No

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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: 03/02/2026

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