Project Cover Page

The Health Center Program Application Forms

Documents and Forms

Document Name Document Type
Form 12 Project Cover Page Form and Instruction
12 Proposal Cover Page Proposal Cover Page.docm Form and Instruction
12 Proposal Cover Page Proposal Cover Page.docm Form and Instruction

Information Collection (IC) Details

IC Title:	Project Cover Page	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	12	Proposal Cover Page	Proposal Cover Page.docm		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 735	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	735	735
Annual IC Time Burden (Hours)	735	735
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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