Form 37 Participating Health Centers List

The Health Center Program Application Forms

Participating Health Centers List

Participating Health Center List

OMB: 0915-0285

Document [docx]
Download: docx | pdf

OMB No.: 0915-0285. Expiration Date: XX/XX/20XX


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

Participating Health Center List

FOR HRSA USE ONLY


Application Tracking Number

Grant Number





Add Grantee Health Center

Add Look-Alike Health Center



Select

Serial Number

Health Center Type

Health Center Name

City

State

Grant/ LAL Number


Delete





Add to Application








Public Burden Statement: Health centers (section 330 grant funded and Federally Qualified Health Center look-alikes) deliver comprehensive, high quality, cost-effective primary health care to patients regardless of their ability to pay. The Health Center Program application forms provide essential information to HRSA staff and objective review committee panels for application evaluation; funding recommendation and approval; designation; and monitoring. The OMB control number for this information collection is 0915-0285 and it is valid until XX/XX/XXXX. This information collection is mandatory under the Health Center Program authorized by section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b). Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKaren Fitzgerald
File Modified0000-00-00
File Created2021-01-14

© 2024 OMB.report | Privacy Policy