OMB.report

Federal forms, ICRs, and supporting documents

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 Name
Form FQHCLA - 1 Application for Certification as a Federally Qualified Health Center Look-Alike 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All Historical Document Collections

200810-0915-003 Approved without change	Extension without change of a currently approved collection	2008-10-24
200508-0915-003 Approved without change	Extension without change of a currently approved collection	2005-08-23
200205-0915-002 Approved with change	Revision of a currently approved collection	2002-05-20
199906-0915-001 Approved without change	Revision of a currently approved collection	1999-06-09
199702-0915-002 Approved without change	Revision of a currently approved collection	1997-02-21
199312-0915-001 Approved without change	Revision of a currently approved collection	1993-12-28
199009-0915-002 Approved without change	New collection (Request for a new OMB Control Number)	1990-09-10