Checklist for Adding a New Target Population

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 207843

Information Collection (IC) Details

View Information Collection (IC)

Checklist for Adding a New Target Population
 
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 and Instruction 33 Checklist for Adding a New Target Population - track changes Checklist for Adding a New Target Population - track changes.docx Yes Yes Fillable Fileable

Health Health Care Services

 

50 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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 25 0 -25 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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