Dental Assessment Form - Recordkeeping Time

Medical Assessment Form and Dental Assessment Form

OMB: 0970-0466

IC ID: 261420

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Dental Assessment Form - Recordkeeping Time
 
No Unchanged
 
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 Assessment Form ORR Dental Assessment Form.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

ORR Division of Children's Services Records  81 FR 46682

500 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 16,000 0 0 0 0 16,000
Annual IC Time Burden (Hours) 2,720 0 0 0 0 2,720
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment C - Dental Assessment Form Instructional Letter for Dental Providers Attachment C_Dental Assessment Form Instructional Letter for Dental Providers.docx 08/02/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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