Application Form

Million Hearts Hypertension Control Challenge

OMB: 0920-0976

IC ID: 206920

Information Collection (IC) Details

View Information Collection (IC)

Application Form 0920-17AYF
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Application Form Att 3 Revised Application Form clean_08072017.docx Yes Yes Fillable Fileable
Other-This is a reference document that shows changes in track-changes format. Att 3 Revised Application Form track changes_08072017.docx No   Paper Only

Health Illness Prevention

 

500 0
   
Private Sector Businesses or other for-profits, 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 0 0 0 500
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Confirmation Email Attachment 3d Confirmation email 0920-0976.docx 09/19/2016
Screenshots of Updated 2016 Web site Attachment 6 Screenshots 2016 Challenge 0920-0976.pdf 09/19/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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