Information Collection

Children's Hospital GME Annual Report Program Information

IC 182196 under ICR 201008-0915-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
FY2011 CHGME Anual Report Guidance final draft _4_.pdf	Instruction
FY2011_chgme_100-4.pdf	Other-certification
FY2011_chgme_100-5.pdf	Other-checklist
FY2011 HRSA 100-4 10_29-10.pdf	Other-Certification
FY2011 HRSA 100-5 10_29_10.pdf	Other-Checklist
chgme 100-2 chgme 100-2 FY2011_HRSA100-2.xls	Form
chgme_100-3 chgme_100-3 FY2011_HRSA100-3.xls	Form
HRSA100-2 FY2011 HRSA100-2 10_29_10 FY2011 HRSA100-2 10_29_10.xls	Form
HRSA100-3 FY2011 HrSA100-3 10_29_10 FY2011 HRSA100-3 10_29_10.xls	Form

IC Title:

Children's Hospital GME Annual Report Program Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-checklist			FY2011_chgme_100-5.pdf	Yes	Yes	Fillable Fileable
Instruction			FY2011 CHGME Anual Report Guidance final draft _4_.pdf	Yes	Yes	Fillable Fileable
Other-certification			FY2011_chgme_100-4.pdf	Yes	Yes	Fillable Fileable
Form	chgme 100-2	chgme 100-2	FY2011_HRSA100-2.xls	Yes	Yes	Fillable Fileable
Form	chgme_100-3	chgme_100-3	FY2011_HRSA100-3.xls	Yes	Yes	Fillable Fileable
Form	HRSA100-2	FY2011 HRSA100-2 10_29_10	FY2011 HRSA100-2 10_29_10.xls	Yes	Yes	Fillable Fileable
Form	HRSA100-3	FY2011 HrSA100-3 10_29_10	FY2011 HRSA100-3 10_29_10.xls	Yes	Yes	Fillable Fileable
Other-Certification			FY2011 HRSA 100-4 10_29-10.pdf	Yes	Yes	Fillable Fileable
Other-Checklist			FY2011 HRSA 100-5 10_29_10.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	56	-1	57
Annual IC Time Burden (Hours)	4,407	143	4,264
Annual IC Cost Burden (Dollars)	0	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.