Information Collection

Children's Hospital GME Annual Report Program Information

IC 182196 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⚠️ Notice: This information collection may be referencing outdated material.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
chgme AR instructions.doc Instruction
chgme 100-4.doc Other-certification
chgme 100-5.doc Other-checklist
chgme 100-2 chgme 100-2 chgme 100-2.xls Form
chgme 100-3 chgme 100-3 chgme 100-3.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Children's Hospital GME Annual Report Program Information	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			chgme AR instructions.doc	Yes	No	Fillable Printable
Form	chgme 100-2	chgme 100-2	chgme 100-2.xls	Yes	Yes	Fillable Fileable
Form	chgme 100-3	chgme 100-3	chgme 100-3.xls	Yes	Yes	Fillable Fileable
Other-certification			chgme 100-4.doc	Yes	Yes	Fillable Fileable
Other-checklist			chgme 100-5.doc	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)	4,264	4,264
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.