NHHCIA NCC Income Analysis/ Plan Progress Report/ Work Plan Update

The Health Center Program Application Forms

Documents and Forms

Document Name Document Type
Form 6a NHHCIA NCC Income Analysis/ Plan Progress Report/ Work Plan Update Form and Instruction
6a NHHCIA NCC Income Analysis Form NHHCIA NCC Income Analysis Form.docx Form and Instruction
6a NHHCIA NCC Income Analysis Form NHHCIA NCC Income Analysis Form.docx Form and Instruction
6b NHHCIA NCC Project Work Plan Progress Report NHHCIA NCC Project Work Plan Progress Report.docx Form and Instruction
6b NHHCIA NCC Project Work Plan Progress Report NHHCIA NCC Project Work Plan Progress Report.docx Form and Instruction
6c NHHCIA NCC Project Work Plan Update NHHCIA NCC Project Work Plan Update .docx Form and Instruction
6c NHHCIA NCC Project Work Plan Update NHHCIA NCC Project Work Plan Update .docx Form and Instruction

Information Collection (IC) Details

IC Title:	NHHCIA NCC Income Analysis/ Plan Progress Report/ Work Plan Update	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6a	NHHCIA NCC Income Analysis Form	NHHCIA NCC Income Analysis Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	6b	NHHCIA NCC Project Work Plan Progress Report	NHHCIA NCC Project Work Plan Progress Report.docx	Yes	Yes	Fillable Fileable
Form and Instruction	6c	NHHCIA NCC Project Work Plan Update	NHHCIA NCC Project Work Plan Update .docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.