Information Collection Request

Children's Hospital Graduate Medical Education Program

ICR 202210-0915-007 · OMB 0915-0247 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0915-0247 can be found here:

2025-09-30 - Revision of a currently approved collection

Forms and Documents

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

IC Document Collections

IC ID	Collection	Type	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

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/HSA
OMB Control No	0915-0247
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	201910-0915-001
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31