Information Collection

GME Applications

IC 251092 under ICR 202203-0938-005 · OMB 0938-1417.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1417 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10790 GME Applications	Form and Instruction
CMS-10790 Appendix A Proposed Collection Applicant Information for CMS-10790_APPENDIX A_126 PRA Applicant Questions_Revised_508.pdf	Form and Instruction
CMS-10790 Appendix A Proposed Collection Applicant Information for CMS-10790_APPENDIX A_126 PRA Applicant Questions_Revised_508.pdf	Form and Instruction
CMS-10790 GME 126 Sample Application GME 126 Sample Application Final .pdf	Form and Instruction
CMS-10790 GME 126 Sample Application GME 126 Sample Application Final .pdf	Form and Instruction

IC Title:

GME Applications

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 412.278 42 CFR 412.230 42 CFR 412.232 42 CFR 412.256 42 CFR 412.262 42 CFR 412.252 42 CFR 412.268 42 CFR 412.234

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	CMS-10790	Appendix A Proposed Collection Applicant Information for Graduate Medical Education (GME) Section 126	CMS-10790_APPENDIX A_126 PRA Applicant Questions_Revised_508.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10790	GME 126 Sample Application	GME 126 Sample Application Final .pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,325

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,325	1,325
Annual IC Time Burden (Hours)	10,600	10,600
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.