Health Center Controlled Networks Progress Report

The Health Center Program Application Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Document Name Document Type
Form 40 Health Center Controlled Networks Progress Report Form
40 HCCN Progress Report (track changes) HCCN Progress Report (track changes).docx Form
40 HCCN Progress Report Final HCCN Progress Report Final.docx Form

Information Collection (IC) Details

IC Title:	Health Center Controlled Networks Progress Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	40	HCCN Progress Report (track changes)	HCCN Progress Report (track changes).docx		Yes	Yes	Fillable Fileable
Form	40	HCCN Progress Report Final	HCCN Progress Report Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 93	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	93	93
Annual IC Time Burden (Hours)	2,325	2,325
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.