THCGME Reconciliation Tool

Reconciliation Tool for the Teaching Health Centers Graduate Medical Education Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0342 can be found here:

Documents and Forms

Document Name Document Type
Form 1 THCGME Reconciliation Tool Form
1 Reconciliation Tool Reconciliation_Tool 052611.docx Form
Reconciliation_Tool_Instructions 052611.docx Instructions for Reconciliation Tool IC Document

Information Collection (IC) Details

IC Title:	THCGME Reconciliation Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Reconciliation Tool	Reconciliation_Tool 052611.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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 Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	255	255
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions for Reconciliation Tool	Reconciliation_Tool_Instructions 052611.docx	06/02/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.