Need for Assitance Worksheet

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 180783

Information Collection (IC) Details

View Information Collection (IC)

Need for Assitance Worksheet
 
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 9 Need for Assistance Worksheet Form 9 (track changes).doc Yes Yes Fillable Fileable
Form 9 Need for Assistance Worksheet Final Form 9 - 2017.docx Yes Yes Fillable Fileable

Health Health Care Services

 

500 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 500 0 -150 0 0 650
Annual IC Time Burden (Hours) 2,250 0 -1,000 0 0 3,250
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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