GME Applications

Medicare-Funded GME Residency Positions in accordance with Section 126 of the Consolidated Appropriations Act, 2020 (Public Law 116-93) (CMS-10790)

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.