Form 3A: FQHC Look-Alike Budget Information

The Health Center Program Application Forms

OMB: 0915-0285

IC ID: 239173

Documents and Forms
Information Collection (IC) Details

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Form 3A: FQHC Look-Alike Budget Information
 
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 18 Form 3A - clean.docx Form 3A - clean.docx Yes Yes Fillable Fileable
Form and Instruction 18E Form 3A - edits.docx Form 3A - edits.docx Yes Yes Fillable Fileable

Health Health Care Services

 

50 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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 50 0 0 0 0 50
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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