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Attachment C - Dental Assessment Form Instructional Letter for Dental Providers
Attachment C_Dental Assessment Form Instructional Letter for Dental Providers.docx
Medical Assessment Form and Dental Assessment Form
Attachment C - Dental Assessment Form Instructional Letter for Dental Providers
OMB: 0970-0466
OMB.report
HHS/ACF
OMB 0970-0466
ICR 202312-0970-002
IC 261420
Attachment C - Dental Assessment Form Instructional Letter for Dental Providers
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⚠️ Notice: This form may be outdated.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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