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Federal forms, ICRs, and supporting documents

Information Collection

CHGME Payment Program HRSA 100-2 and HRSA 100-3 Annual Report Forms

IC 182196 under ICR 201308-0915-001 · OMB 0915-0313.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-hrsaform1004_2013
Other-hrsaform1005_2013
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

CHGME Payment Program HRSA 100-2 and HRSA 100-3 Annual Report Forms
 
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 and Instruction 100-2 HRSA 100-2 FY13 - Redesign HRSA 100-2 FY13 - Redesign.xlsm Yes Yes Fillable Printable
Other-hrsaform1004_2013 hrsaform1004_2013.pdf Yes Yes Fillable Printable
Form and Instruction 100-3 HRSA 100-3_FY13 HRSA 100-3_FY13.xlsm Yes Yes Fillable Printable
Other-hrsaform1005_2013 hrsaform1005_2013.pdf Yes Yes Fillable Printable

Health Consumer Health and Safety

 

54 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 54 0 0 -2 0 56
Annual IC Time Burden (Hours) 3,996 0 0 -411 0 4,407
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.