Checklist for Replacing Existing Service Delivery Site

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 193524

Information Collection (IC) Details

View Information Collection (IC)

Checklist for Replacing Existing 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 replacing existing service delivery site 22. Checklist for Replacing Existing 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 0 0 700
Annual IC Time Burden (Hours) 1,400 0 0 0 0 1,400
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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