Children's Hospital Graduate Medical Education Program

ICR 202210-0915-007

OMB: 0915-0247

Federal Form Document

Forms and Documents

Document Name	Status
Form 99-2 R HRSA 99-2 (Reconcilliation) Form	Modified
Form 99-1 S HRSA 99-1 Supplemental (FTE Resident Assessment) Form	Modified
Form 99-1 R HRSA 99-1 (Reconcilliation) Form	Modified
Form S Exhibit S (Resident FTE Assessment) Form	Modified
Form P Exhibit P (Resident FTE Assessment) Form	Modified
Form O2 Exhibit O(2) (Resident FTE Assessment) Form	Modified
Form O(1) Exhibit O(1) (Resident FTE Assessment) Form	Modified
Form N Exhibit N (Resident FTE Assessment) Form	Modified
Form C Exhibit C (Resident FTE Assessment) Form	Modified
Form CR Conversation Record (Resident FTE Assessment) Form	Modified
Form 99-5 I & R HRSA 99-5 (Initial and Reconciliation) Form	Modified
Form 99-4 R HRSA 99-4 (Reconciliation) Form	Modified
Form 99-2 I HRSA 99-2 (Initial) Form	Modified
Form 99-1 HRSA 99-1 (Initial) Form	Modified
Form 99 I and R HRSA 99 (Initial and Reconcilation) Form	Modified
CHGME Application Guidance.docx Supplementary Document	2022-10-27
CHGME & THCGME FTE Resident Assessment - Supporting Statement A.docx Supporting Statement A	2022-11-02

IC Document Collections

IC ID	Document Title	Status
256635	Exhibit E (Fiscal Intermediary Introductory Request Letter) Other-no form-provided by grantee	New
237997	Exhibit 4 (FTE Resident Assessment) Other-no form-provided by grantee	Modified
237996	Exhibit 3 (FTE Resident Assessment) Other-no form-provided by grantee	Modified
237995	Exhibit 2 (FTE Resident Assessment) Other-no form-provided by grantee	Modified
237994	Exhibit P(2) (FTE Resident Assessment) Other-no form-provided by grantee	Modified
237993	Application Cover Letter (Reconciiation) Other-no form-provided by grantee	Removed
237991	HRSA 99-2 (Reconcilliation) Form	Modified
224952	HRSA 99-1 Supplemental (FTE Resident Assessment) Form	Modified
224950	HRSA 99-1 (Reconcilliation) Form	Modified
211283	Exhibit S (Resident FTE Assessment) Form	Modified
211282	Exhibit P (Resident FTE Assessment) Form	Modified
211281	Exhibit O(2) (Resident FTE Assessment) Form	Modified
211280	Exhibit O(1) (Resident FTE Assessment) Form	Modified
211279	Exhibit N (Resident FTE Assessment) Form	Modified
211278	Exhibit C (Resident FTE Assessment) Form	Modified
211277	Conversation Record (Resident FTE Assessment) Form	Modified
211276	Exhibit 1 (Resident FTE Assessment) Other-no form-provided by grantee	Modified
211275	Exhibit 2 (Initial and Reconciliation) Other-no form-provided by grantee	Modified
211274	Exhibit 3 (Initial and Reconciliation) Other-no form-provided by grantee	Modified
211273	Exhibit 4 (Initial and Reconciliation) Other-no form-provided by grantee	Modified
211272	Exhibit F (Resident FTE Assessment) Other-no form-provided by grantee	Modified
211270	Exhibit T (Resident FTE Assessment) Other-no form-provided by grantee	Modified
211269	Exhibit T(1) (Resident FTE Assessment) Other-no form-provided by grantee	Modified
211268	FTE Assessment Letter (Resident FTE Assessment) Other-no form-provided by grantee	Removed
211222	CFO Cover Letter (Initial and Reconciliation) Other-no form-provided by grantee	Modified
211221	Application Cover Letter (initial and reconciliation) Other-not provided by grantee	Modified
211220	HRSA 99-5 (Initial and Reconciliation) Form	Modified
211219	HRSA 99-4 (Reconciliation) Form	Modified
211217	HRSA 99-2 (Initial) Form	Modified
211216	HRSA 99-1 (Initial) Form	Modified
211215	HRSA 99 (Initial and Reconcilation) Form	Modified