
2026.08.2064
This page provides the official government form from the Health and Human Services Department. The summary below is quoted from the agency source.
In compliance with the Paperwork Reduction Act of 1995, HRSA submitted an Information Collection Request (ICR) to the Office of Management and Budget (OMB) for review and approval. Comments submitted during the first public review of this ICR will be provided to OMB. OMB will accept further comments from the public during the review and approval period. OMB may act on HRSA's ICR only after the 30-day comment period for this notice has closed.
Source: Federal Register — Health and Human Services Department. Official form page · Official PDF. Quoted material remains the agency’s; this firm page is a reference only.