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OMB Control No: 0915-0151	ICR Reference No: 202602-0915-001
Status: Received in OIRA	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	Date Submitted to OIRA: 03/02/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	68	68
Time Burden (Hours)	1,811	1,810
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	68	68	-68	68
Annual Time Burden (Hours)	1,811	1,810	-1,809	1,810
Annual Cost Burden (Dollars)	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.

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

Agency Contact: Laura Cooper 301 443-2126 lcooper@hrsa.gov

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