Form 1 Equipment List

The Health Center Program Application Forms

25. Equipment List

Equipment List

OMB: 0915-0285

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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Health Resources and Services Administration

EQUIPMENT LIST

FOR HRSA USE ONLY


Application Tracking Number


Grant Number


Project Number



Project Type



Project Title



List of Equipment


Type

Description

Unit Price

Quantity

Total Price


[_] Clinical

[_] Non Clinical

[_] Mobile Van






[_] Clinical

[_] Non Clinical

[_] Mobile Van






[_] Clinical

[_] Non Clinical

[_] Mobile Van






[_] Clinical

[_] Non Clinical

[_] Mobile Van






[_] Clinical

[_] Non Clinical

[_] Mobile Van






Total





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSBHCC Forms in WORD Format
AuthorKinny Padh
File Modified0000-00-00
File Created2021-01-26

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