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Supporting Statement A_Medical Assessment Form and Dental Assessment Form
Supporting Statement A_Medical Assessment Form and Dental Assessment Form.docx
Medical Assessment Form and Dental Assessment Form
OMB: 0970-0466
OMB.report
HHS/ACF
OMB 0970-0466
ICR 202312-0970-002
Supporting Statement A_Medical Assessment Form and Dental Assessment Form
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0466 can be found here:
2025-02-15 - No material or nonsubstantive change to a currently approved collection
2024-10-07 - No material or nonsubstantive change to a currently approved collection
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