Information Collection

Children's Hospitals Graduate Medical Education Quality Bonus System (QBS) Initiative Response Form

IC 234990 under ICR 201902-0906-001 · OMB 0906-0041.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Children's Hospitals Graduate Medical Education Quality Bonus System (QBS) Initiative Response Form	Form and Instruction
CHGME Program Quality Bonus Payment System Initiatives Reporting Form Instructions_CLEAN.docx	Instruction
1 : CHGME Program Quality Bonus Payment System Initiatives CHGME Program Quality Bonus Payment System Initiatives Reporting Form.pdf	Form and Instruction

IC Title:

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:

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	: CHGME Program Quality Bonus Payment System Initiatives Reporting Form.pdf	CHGME Program Quality Bonus Payment System Initiatives Reporting Form.pdf		Yes	Yes	Fillable Fileable
Instruction			CHGME Program Quality Bonus Payment System Initiatives Reporting Form Instructions_CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	58	58
Annual IC Time Burden (Hours)	1,880	1,880
Annual IC Cost Burden (Dollars)	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.