Health Center Controlled Networks (HCCN) Progress Report Table

The Health Center Program Application Forms

Documents and Forms

Document Name Document Type
Form 10a Health Center Controlled Networks (HCCN) Progress Report Table Form and Instruction
10a HCCN Progress Report HCCN Progress Report - clean.docx Form and Instruction
10a HCCN Progress Report HCCN Progress Report - clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Health Center Controlled Networks (HCCN) Progress Report Table	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	10a	HCCN Progress Report	HCCN Progress Report - clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	90	90
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.