QIF Progress Report

The Health Center Program Application Forms

Documents and Forms

Document Name Document Type
Form 1a QIF Progress Report Form and Instruction
1a QIF Progress Report QIF Progress Report.docx Form and Instruction
1a QIF Progress Report QIF Progress Report.docx Form and Instruction
1a_Revised Clean QIF TJI Progress Report QIF TJI Progress Report_11_26_2024_V2_OAA approved_CLEAN_FINAL.docx Form and Instruction
1a_Revised Clean QIF TJI Progress Report QIF TJI Progress Report_11_26_2024_V2_OAA approved_CLEAN_FINAL.docx Form and Instruction
1a_Redline QIF TJI Progress Report Redline QIF TJI Progress Report_11_26_2024_V2_OAA approved_MARKED_FINAL.docx Form and Instruction
1a_Redline QIF TJI Progress Report Redline QIF TJI Progress Report_11_26_2024_V2_OAA approved_MARKED_FINAL.docx Form and Instruction

Information Collection (IC) Details

IC Title:	QIF Progress Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1a	QIF Progress Report	QIF Progress Report.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1a_Revised Clean	QIF TJI Progress Report	QIF TJI Progress Report_11_26_2024_V2_OAA approved_CLEAN_FINAL.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1a_Redline	QIF TJI Progress Report Redline	QIF TJI Progress Report_11_26_2024_V2_OAA approved_MARKED_FINAL.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	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	12	12
Annual IC Time Burden (Hours)	18	18
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.