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⚠️ Notice: This information collection may be referencing outdated material.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

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

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: Modified

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
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 %

	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

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.