Information Collection

Reconciliation Tool for the Teaching Health Center Graduate Medical Education Program

IC 197986 under ICR 201706-0915-001 · OMB 0915-0342.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Reconciliation Tool for the Teaching Health Center Graduate Medical Education Program	Form and Instruction
THCGME Reconciliation Tool Instructions FINAL.docx	Instruction
1 Attachment 1-THCGME Reconciliation Tool Form.docx Attachment 1-THCGME Reconciliation Tool Form.docx	Form and Instruction

IC Title:

Reconciliation Tool for the Teaching Health Center Graduate Medical Education Program

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Attachment 1-THCGME Reconciliation Tool Form.docx	Attachment 1-THCGME Reconciliation Tool Form.docx		Yes	Yes	Fillable Fileable
Instruction			THCGME Reconciliation Tool Instructions FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	59	15	44
Annual IC Time Burden (Hours)	118	30	88
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.