Other Activities/Locations

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 180778

Information Collection (IC) Details

View Information Collection (IC)

Other Activities/Locations
 
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 5C Other Activities/Locations Form 5C - Other Activities Locations (track changes).docx Yes Yes Fillable Fileable
Form 5C Other Activities/Locations Final Form 5C - Other Activities Locations.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,000 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 1,000 0 -600 0 0 1,600
Annual IC Time Burden (Hours) 500 0 -300 0 0 800
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.

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