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Application To Participate In The Public Health Capitation Program, 42 Cfr 57

IC 110271 under ICR 198901-0915-001 · OMB 0915-0089.

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APPLICATION TO PARTICIPATE IN THE PUBLIC HEALTH CAPITATION PROGRAM, 42 CFR 57
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HRSA-528 No No


    

26 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 52 0 0 52 0 0
Annual IC Time Burden (Hours) 182 0 0 182 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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