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Ryan White HIV/AIDS Program Dental Services Report.(State/Local/Tribal)

IC 6384 under ICR 202602-0915-001 · OMB 0915-0151.

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Ryan White HIV/AIDS Program Dental Services Report.(State/Local/Tribal)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Dental Reimbursement Program (DRP) Form 0915-0151 Dental Reimbursement Program Form - DSR - Revision - 02172026.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

34 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 34 0 -34 0 0 68
Annual IC Time Burden (Hours) 1,088 0 -722 0 0 1,810
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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