The Health Center Program Application Forms

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 180782

Information Collection (IC) Details

View Information Collection (IC)

The Health Center Program Application Forms
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0285 certification 0285 certification 0285 hc certification.doc Yes Yes Fillable Fileable

Health Health Care Services

 

250 0
   
Private Sector Not-for-profit institutions
 
   100 %

  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 250 0 0 250 0 0
Annual IC Time Burden (Hours) 125 0 0 125 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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