Diabetes Action Plan - Quarterly Report Template

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 223047

Information Collection (IC) Details

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Diabetes Action Plan - Quarterly Report Template
 
No Removed
 
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 8 Diabetes Action Plan Quarterly Report.docx Diabetes Action Plan Quarterly Report.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,058 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 0 0 0 -4,232 0 4,232
Annual IC Time Burden (Hours) 0 0 0 -8,464 0 8,464
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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