HEALTH SYSTEMS AGENCY APPLICATION GUIDELINES FOR DESIGNATION AND GRANT AND RELATED REPORTING REQUIREMENTS

ICR 198310-0935-001

OMB: 0935-0071

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0935-0071 198310-0935-001
Historical Active 198312-0915-009
HHS/AHRQ
HEALTH SYSTEMS AGENCY APPLICATION GUIDELINES FOR DESIGNATION AND GRANT AND RELATED REPORTING REQUIREMENTS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/08/1983
Retrieve Notice of Action (NOA) 10/24/1983
  Inventory as of this Action Requested Previously Approved
09/30/1984 09/30/1984
131 0 0
6,550 0 0
0 0 0

PUBLIC LAW 96-79, HEALTH PLANNING AND RESOURCES DEVELOPMENT AMENDMENTS OF 1979, PROVIDES GRANTS FOR HEALTH SYSTEMS AGENCIES. APPLICATION AND REPORTING SYSTEM WILL OBTAIN INFORMATION NEEDED TO DESIGNATE AND MAKE GRANT AWARDS TO APPLICANT BASED ON A DESCRIPTION OF APPLICANTS ORGANIZATION/STAFF AND HOW IT SILL PERFORM MANDATED FUNCTIONS PER SECTION 1535.

None
None


No

1
IC Title Form No. Form Name
HEALTH SYSTEMS AGENCY APPLICATION GUIDELINES FOR DESIGNATION AND GRANT AND RELATED REPORTING REQUIREMENTS PHS-5161, HRA-217, HRA-2172

  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 131 0 0 131 0 0
Annual Time Burden (Hours) 6,550 0 0 6,550 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
10/24/1983


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