Information Collection

The Health Center Program Application Forms

IC 6538 under ICR 201010-0915-006 · OMB 0915-0285.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0285-1a The Health Center Program Application Forms	Form
0285-1a General Info Worksheet 1A-GenInfoWorksheet.doc	Form
FORM 1A instructions.doc Form Instructions	IC Document

IC Title:

The Health Center Program Application Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0285-1a	General Info Worksheet	1A-GenInfoWorksheet.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,034

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,034	1,034
Annual IC Time Burden (Hours)	2,068	2,068
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form Instructions	FORM 1A instructions.doc	06/14/2010

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