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

ICR 198106-0935-003

OMB: 0935-0017

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0935-0017 198106-0935-003
Historical Active 198007-0935-001
HHS/AHRQ
HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS
No material or nonsubstantive change to a currently approved collection   No
Emergency 06/29/1981
Approved with change 06/29/1981
Retrieve Notice of Action (NOA) 06/29/1981
  Inventory as of this Action Requested Previously Approved
09/30/1981 09/30/1981 06/30/1981
204 0 204
13,260 0 13,260
0 0 0

P.L. 96-79-HEALTH PLANNING AND RESOURCES DEVELOPMENT AMMENDMENTS OF 1979 - PROVIDES GRANTS FOR HEALTH SYSTEMS AGENCIES. APPLICATION AND REPORTING SYSTEM OBTAINS INFORMATION NEEDED TO DESIGNATE AND MAKE GRANT AWARD TO APPLICANT BASED ON WORK PROGRAM WHICH IS A DESCRIPTION OF APPLICANT'S ORGANIZATION AND STAFF AND HOW IT PERFOMS STATUTORILY MANDATED FUNCTIONS. INFORMATION IS USED TO FULFULL SECTION 1535(B) REQUIREMENT TO ENSURE AGENCY COMPLIANCE IN TERMS OF STRUCTURE AN

None
None


No

1
IC Title Form No. Form Name
HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS 217-1, 217-2, 217-3

  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 204 204 0 0 0 0
Annual Time Burden (Hours) 13,260 13,260 0 0 0 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.
06/29/1981


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