Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
The Health Center Program Application Forms New 1021 15315 0 Form 0285 income analysis 0285 income analysis
The Health Center Program Application Forms New 1021 6126 0 Form 0285 staff profile 0285 staff profile
The Health Center Program Application Forms New 1021 511 0 Form 0285 services provided 0285 services provided
The Health Center Program Application Forms New 1021 1021 0 Form 0285 sites 0285 sites
The Health Center Program Application Forms New 150 150 0 Form 0285 waiver 0285 waiver
The Health Center Program Application Forms New 1021 511 0 Form 0285 compliance 0285 compliance
The Health Center Program Application Forms New 250 125 0 Form 0285 certification 0285 certification
The Health Center Program Application Forms New 700 350 0 Form 0285 other site activities 0285 other site activities
The Health Center Program Application Forms New 1021 1021 0 Form 0285 Board members 0285 Board members
The Health Center Program Application Forms New 1021 511 0 Form 0285 affiliation checklist 0285 hc affiliation checklist
The Health Center Program Application Forms New 900 5400 0 Form 0285 need for assistance 0285 need for assistance
Instruction
The Health Center Program Application Forms New 1021 1021 0 Form 0285 emergency preparedness 0285 emergency preparedness
The Health Center Program Application Forms New 800 800 0 Form 0285 ftca form 0285 ftca form
The Health Center Program Application Forms New 800 400 0 Form 0285 contact information 0285 contact information
The Health Center Program Application Forms Modified 1021 3063 0 Form 0285 1 0285 general information worksheet
The Health Center Program Application Forms New 1021 511 0 Form 0285 funding 0285 funding summary
The Health Center Program Application Forms New 300 3600 0 Form 0285 planning 0285 planning worksheet
The Health Center Program Application Forms New 1021 12252 0 Form 0285 community characteristics 0285 community characteristics
Total burden requested under this ICR: 15131 52688 0  
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