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Form 1C: Documents on File
The Health Center Program Application Forms
OMB: 0915-0285
IC ID: 180772
OMB.report
HHS/HSA
OMB 0915-0285
ICR 202411-0915-001
IC 180772
( )
Documents and Forms
Document Name
Document Type
Form 15
Form 1C: Documents on File
Form and Instruction
15 Form 1C - clean.docx
Form 1C - clean.docx
Form and Instruction
15 Form 1C - clean.docx
Form 1C - clean.docx
Form and Instruction
15E Form 1C edits.docx
Form 1C edits.docx
Form and Instruction
15E Form 1C edits.docx
Form 1C edits.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Form 1C: Documents on File
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
15
Form 1C - clean.docx
Form 1C - clean.docx
Yes
Yes
Fillable Fileable
Form and Instruction
15E
Form 1C edits.docx
Form 1C edits.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,058
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 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
1,058
0
0
0
0
1,058
Annual IC Time Burden (Hours)
529
0
0
0
0
529
Annual IC Cost Burden (Dollars)
0
0
0
0
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.