OMB control number
Application for Certification as a Federally Qualified Health Center Look-Alike
OMB 0915-0142 · HHS/HSA.
OMB 0915-0142
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form FQHCLA - 1 FQHC Look Alike PIN | Form and Instruction |
| 0142_regs.pdf | Supplementary Document |
| 0142_Law.pdf | Supplementary Document |
| 0142_Health_Centers_Act.pdf | Supplementary Document |
| ss 0142 - 2008.pdf | Supporting Statement A |
 Application for Certification as a Federally Qualified Health Center Look-Alike |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 200810-0915-003 | Extension without change of a currently approved collection | 2008-10-24 | Approved without change | |
| 200508-0915-003 | Extension without change of a currently approved collection | 2005-08-23 | Approved without change | |
| 200205-0915-002 | Revision of a currently approved collection | 2002-05-20 | Approved with change | |
| 199906-0915-001 | Revision of a currently approved collection | 1999-06-09 | Approved without change | |
| 199702-0915-002 | Revision of a currently approved collection | 1997-02-21 | Approved without change | |
| 199312-0915-001 | Revision of a currently approved collection | 1993-12-28 | Approved without change | |
| 199009-0915-002 | New collection (Request for a new OMB Control Number) | 1990-09-10 | Approved without change |