APPLICATION TO PARTICIPATE IN THE HEALTH PROFESSIONS CAPITATION PROGRAM

ICR 198406-0915-001

OMB: 0915-0089

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0915-0089 198406-0915-001
Historical Active
HHS/HSA
APPLICATION TO PARTICIPATE IN THE HEALTH PROFESSIONS CAPITATION PROGRAM
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/20/1984
Retrieve Notice of Action (NOA) 06/06/1984
  Inventory as of this Action Requested Previously Approved
09/30/1984 09/30/1984
23 0 0
138 0 0
0 0 0

FORM AND INSTRUCTIONS ARE NEEDED TO ENABLE ELIGIBLE SCHOOLS OF PUBLIC HEALTH TO APPLY FOR HEALTH PROFESSIONS CAPITATION GRANTS.

None
None


No

1
IC Title Form No. Form Name
APPLICATION TO PARTICIPATE IN THE HEALTH PROFESSIONS CAPITATION PROGRAM HRA-83

  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 23 0 0 0 23 0
Annual Time Burden (Hours) 138 0 0 0 138 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.
06/06/1984


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