Supportive Services Other Public Burden Statement / /
Organization
Preventive Dental Pharmaceutical Services HCH Required Substance Abuse Services Case Management Eligibility Assistance Health Education Outreach Transportation Translation DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources / Services Administration FOR HRSA USE ONLY Grant Number Application Tracking / Health Center / DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration FOR HRSA USE ONLY Grant Number Application Tracking / /
Form 5A: Services Provided