Checklist for Adding New Service

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 193522

Information Collection (IC) Details

View Information Collection (IC)

Checklist for Adding New Service
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Checklist for Adding New Service -Clean.docx Checklist for Adding New Service -Clean.docx Yes Yes Fillable Fileable
Form and Instruction 2E Checklist for Adding New Service edits.docx Checklist for Adding New Service edits.docx Yes Yes Fillable Fileable

Health Health Care Services

 

450 0
   
Private Sector 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 450 0 0 0 0 450
Annual IC Time Burden (Hours) 900 0 0 0 0 900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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