Checklist for Adding New Service

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 193522

Information Collection (IC) Details

View Information Collection (IC)

Checklist for Adding New Service
 
No Unchanged
 
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 new service 20. Checklist for Adding New Service.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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