Checklist for Adding a new Service Delivery Site

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 193525

Information Collection (IC) Details

View Information Collection (IC)

Checklist for Adding a new Service Delivery Site
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Checklist for Adding a New Service Delivery Site 18. Checklist for Adding a New Service Delivery Site.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

700 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 700 0 0 600 0 100
Annual IC Time Burden (Hours) 1,400 0 0 1,300 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy