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Health Systems Agency Application For Designation, Grant Applications And Related Report Forms

IC 165968 under ICR 198106-0935-003 · OMB 0935-0017.

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HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 217-1 No No
Form 217-2 No No
Form 217-3 No No


    

204 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 204 0 0 0 0 204
Annual IC Time Burden (Hours) 13,260 0 0 0 0 13,260
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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