Information Collection

DoDEA Form 1307 "Sure Start Medical/Dental Examination"

IC 239956 under ICR 202604-0704-002 · OMB 0704-0495.

Documents and Forms

Document Name Document Type
Form DoD Form 1307 Sure Start Medical/Dental Examination DoDEA Form 1307 "Sure Start Medical/Dental Examination" Form and Instruction
DoD Form 1307 Sure Start Medical/Dental Examination DoDEA Form 1307, Sure Start Medical Dental Examination (May 2023).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DoDEA Form 1307 "Sure Start Medical/Dental Examination"	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	DoD Form 1307	Sure Start Medical/Dental Examination	DoDEA Form 1307, Sure Start Medical Dental Examination (May 2023).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: DoDEA 26	FR Citation: 76 FR 24001

Number of Respondents: 550	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	550	-400	950
Annual IC Time Burden (Hours)	138	-100	238
Annual IC Cost Burden (Dollars)	996	-724	1,720

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.

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