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⚠️ Notice: This information collection may be referencing outdated material.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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.