HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS

ICR 198004-0935-001

OMB: 0935-0017

Federal Form Document

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Status
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ICR Details
0935-0017 198004-0935-001
Historical Active 198001-0935-001
HHS/AHRQ
HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 04/18/1980
Retrieve Notice of Action (NOA) 04/18/1980
  Inventory as of this Action Requested Previously Approved
06/30/1980 06/30/1980
205 0 0
1,840 0 0
0 0 0



None
None


No

1
IC Title Form No. Form Name
HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 205 0 0 0 205 0
Annual Time Burden (Hours) 1,840 0 0 0 1,840 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/18/1980


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