View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0915-0293	ICR Reference No: 200503-0915-001
Status: Historical Inactive	Previous ICR Reference No: 200409-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Free Clinics FTCA Program Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 06/30/2005
	Date Received in OIRA: 03/24/2005
Terms of Clearance: Withdrawn per agency request submitted to OMB 06/28/05.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2005	06/30/2008	08/31/2005
Responses	600	0	600
Time Burden (Hours)	3,000	0	0
Cost Burden (Dollars)	0	0	0

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.