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Application To Participate In The Health Professions Capitation Grant Program

IC 112069 under ICR 197910-0935-001 · OMB 0935-0006.

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Information Collection (IC) Details

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APPLICATION TO PARTICIPATE IN THE HEALTH PROFESSIONS CAPITATION GRANT PROGRAM
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HRA83 No No


    

350 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 350 0 0 350 0 0
Annual IC Time Burden (Hours) 1,050 0 0 1,050 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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