Information Collection

Health Center Community Engagement Network (CEN) – New Applicant Toolkit Project

IC 271015 under ICR 202306-0915-006 · OMB 0915-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BPHC-CEN Facilitator Guide - New Applicant Toolkit - to OMB 09172024.docx	Instruction
PRA BPHC Generic IC Memo Toolkit_to OMB 09172024.docx Generic IC Memo to OMB	IC Document

IC Title:

Health Center Community Engagement Network (CEN) â New Applicant Toolkit Project

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic IC Memo to OMB		09/17/2024

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

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