CHGME Payment Program HRSA 100-2 and HRSA 100-3 Annual Report Forms

Children's Hospital Graduate Medical Education Program Annual Report

Documents and Forms

Document Name Document Type
Form 100-2 CHGME Payment Program HRSA 100-2 and HRSA 100-3 Annual Report Forms Form and Instruction
hrsaform1004_2013.pdf Other-hrsaform1004_2013
hrsaform1005_2013.pdf Other-hrsaform1005_2013
100-2 HRSA 100-2 FY13 - Redesign HRSA 100-2 FY13 - Redesign.xlsm Form and Instruction
100-3 HRSA 100-3_FY13 HRSA 100-3_FY13.xlsm Form and Instruction

Information Collection (IC) Details

IC Title:	CHGME Payment Program HRSA 100-2 and HRSA 100-3 Annual Report Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	100-2	HRSA 100-2 FY13 - Redesign	HRSA 100-2 FY13 - Redesign.xlsm	Yes	Yes	Fillable Printable
Other-hrsaform1004_2013			hrsaform1004_2013.pdf	Yes	Yes	Fillable Printable
Form and Instruction	100-3	HRSA 100-3_FY13	HRSA 100-3_FY13.xlsm	Yes	Yes	Fillable Printable
Other-hrsaform1005_2013			hrsaform1005_2013.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	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	54	-2	56
Annual IC Time Burden (Hours)	3,996	-411	4,407
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.