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COVID–19 Provider Relief Programs Application and Attestation Portal, and Claims Reimbursement Submission Activities
OMB 0906-0069
OMB.report
HHS/HRSA
OMB 0906-0069
OMB 0906-0069
Latest Forms, Documents, and Supporting Material
Document
Name
Form 4 Uninsured Provider (UIP) Application
Form
Form 3 Coverage Assistance Fund (CAF) Application
Form
Form 2 PRF and ARP-R Application Portal
Form
Form 1 Provider Relief Fund (PRF) and American Rescue Plan Act Rural (ARP-R) Attestation Portal
Form
Supporting Statement A.docx
Supporting Statement A
Uninsured Provider (UIP) Application
Form
Coverage Assistance Fund (CAF) Application
Form
PRF and ARP-R Application Portal
Form
Provider Relief Fund (PRF) and American Rescue Plan Act Rural (ARP-R) Attestation Portal
Form
All Historical Document Collections
202201-0906-002
Approved without change
New collection (Request for a new OMB Control Number)
2022-01-21
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