Health Center Controlled Networks Work Plan

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⚠️ Notice: This information collection may be referencing outdated material.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 41 Health Center Controlled Networks Work Plan Form
41 HCCN Work Plan (track changes) HCCN Work Plan (track changes).docx Form
41 HCCN Work Plan 2016 Cohort.pdf HCCN Work Plan 2016 Cohort.pdf Form

Information Collection (IC) Details

IC Title:	Health Center Controlled Networks Work Plan	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	41	HCCN Work Plan (track changes)	HCCN Work Plan (track changes).docx		Yes	Yes	Fillable Fileable
Form	41	HCCN Work Plan 2016 Cohort.pdf	HCCN Work Plan 2016 Cohort.pdf		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)	465	465
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.