Information Collection

Children's Hospital GME Annual Report Screeing Instrument

IC 182195 under ICR 200709-0915-004 · OMB 0915-0313.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0313 can be found here:

Documents and Forms

Document Name Document Type
Form chgme 100-1 Children's Hospital GME Annual Report Screeing Instrument Form
chgme 100-1 chgme 100-1 chgme 100-1.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Children's Hospital GME Annual Report Screeing Instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	chgme 100-1	chgme 100-1	chgme 100-1.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	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 New Statute
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	570	570
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.