Information Collection

Instructions to Update the Fluoridation Status and Population Data

IC 239185 under ICR 202001-0920-003 · OMB 0920-1319.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1319 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-19DO Instructions to Update the Fluoridation Status and Population Data Form and Instruction
0920-19DO Instructions to Update the Fluoridation Status and Popul 19DO Att. 2a Fluoridation Status Instructions Final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Instructions to Update the Fluoridation Status and Population Data	Agency IC Tracking Number:	0920-19DO

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-19DO	Instructions to Update the Fluoridation Status and Population Data	19DO Att. 2a Fluoridation Status Instructions Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	1,875	1,875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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