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Form 23 Form 6A - Clean
The Health Center Program Application Forms
Form 6A - Clean
Form 6A: Current Board Member Characteristics
OMB: 0915-0285
OMB.report
HHS/HSA
OMB 0915-0285
ICR 202301-0915-005
IC 180779
Form 23 Form 6A - Clean
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0915-0285 can be found here:
2025-05-21 - No material or nonsubstantive change to a currently approved collection
2024-11-26 - No material or nonsubstantive change to a currently approved collection
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