Children's Hospital Graduate Medical Education Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 99-2 R HRSA 99-2 (Reconciliation)	Form	Modified	Available
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	Available
Form 99-1 S HRSA 99-1 Supplemental (FTE Resident Assessment)	Form	Modified	Repair queued
Form 99-1 R HRSA 99-1 (Reconciliation)	Form	Modified	Available
Form 99-1 R HRSA 99-1 (Reconcilliation)	Form	Modified	Available
Form S Exhibit S (FTE Resident Assessment)	Form	Modified	Available
Form S Exhibit S (Resident FTE Assessment)	Form	Modified	Repair queued
Form P Exhibit P (FTE Resident Assessment)	Form	Modified	Available
Form P Exhibit P (Resident FTE Assessment)	Form	Modified	Repair queued
Form O2 Exhibit O(2) (FTE Resident Assessment)	Form	Modified	Available
Form O2 Exhibit O(2) (Resident FTE Assessment)	Form	Modified	Repair queued
Form O(1) Exhibit O(1) (FTE Resident Assessment)	Form	Modified	Available
Form O(1) Exhibit O(1) (Resident FTE Assessment)	Form	Modified	Repair queued
Form N Exhibit N (FTE Resident Assessment)	Form	Modified	Available
Form N Exhibit N (Resident FTE Assessment)	Form	Modified	Repair queued
Form C Exhibit C (FTE Resident Assessment)	Form	Modified	Available
Form C Exhibit C (Resident FTE Assessment)	Form	Modified	Repair queued
Form CR Conversation Record (FTE Resident Assessment)	Form	Modified	Available
Form CR Conversation Record (Resident FTE Assessment)	Form	Modified	Repair queued
Form 99-5 I & R HRSA 99-5 (Initial and Reconciliation)	Form	Modified	Available
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	Available
Form 99-4 R HRSA 99-4 (Reconciliation)	Form	Modified	Repair queued
Form 99-2 I HRSA 99-2 (Initial)	Form	Modified	Available
Form 99-2 I HRSA 99-2 (Initial)	Form	Modified	Repair queued
Form 99-1 HRSA 99-1 (Initial)	Form	Modified	Available
Form 99-1 HRSA 99-1 (Initial)	Form	Modified	Repair queued
Form 99 I and R HRSA 99 (Initial and Reconciliation)	Form	Modified	Available
Form 99 I and R HRSA 99 (Initial and Reconcilation)	Form	Modified	Repair queued
Comment 2_Kaplan Transmittal 07252025.pdf	Public Comments	Uploaded 2025-07-25	Repair queued
Comment 2_Kaplan 07252025.pdf	Public Comments	Uploaded 2025-07-25	Available
Comment 1_McNaus Transmittal 07252025.pdf	Public Comments	Uploaded 2025-07-25	Available
Comment 1_McNaus 07252025.pdf	Public Comments	Uploaded 2025-07-25	Repair queued
CHGME-ApplicationGuidance- 06.26.24 FINAL.pdf	Supplementary Document	Uploaded 2025-09-30	Repair queued
CHGME-ApplicationGuidance- 06.26.24 FINAL.pdf	Supplementary Document	Uploaded 2025-09-30	Repair queued
GMEs FTE Resident Assessment - SS-A 0915-0247 09112025.docx	Supporting Statement A	Uploaded 2025-09-30	Available
GMEs FTE Resident Assessment - SS-A 0915-0247 09112025.docx	Supporting Statement A	Uploaded 2025-09-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
256635	Exhibit E (Fiscal Intermediary Introductory Request Letter)	Other-no form-provided by grantee	Modified
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
237991	HRSA 99-2 (Reconcilliation)	Form	Modified	HRSA 99-2 (Reconciliation)
237991	HRSA 99-2 (Reconcilliation)	Form	Modified
224952	HRSA 99-1 Supplemental (FTE Resident Assessment)	Form	Modified	HRSA 99-1 (Supplemental FTE Resident Assessment)
224952	HRSA 99-1 Supplemental (FTE Resident Assessment)	Form	Modified
224950	HRSA 99-1 (Reconcilliation)	Form	Modified	HRSA 99-1 (Reconciliation)
224950	HRSA 99-1 (Reconcilliation)	Form	Modified
211283	Exhibit S (Resident FTE Assessment)	Form	Modified	Exhibit S (FTE Resident Assessment)
211283	Exhibit S (Resident FTE Assessment)	Form	Modified
211282	Exhibit P (Resident FTE Assessment)	Form	Modified	Exhibit P (FTE Resident Assessment)
211282	Exhibit P (Resident FTE Assessment)	Form	Modified
211281	Exhibit O(2) (Resident FTE Assessment)	Form	Modified	Exhibit O(2) (FTE Resident Assessment)
211281	Exhibit O(2) (Resident FTE Assessment)	Form	Modified
211280	Exhibit O(1) (Resident FTE Assessment)	Form	Modified	Exhibit O(1) (FTE Resident Assessment)
211280	Exhibit O(1) (Resident FTE Assessment)	Form	Modified
211279	Exhibit N (Resident FTE Assessment)	Form	Modified	Exhibit N (FTE Resident Assessment)
211279	Exhibit N (Resident FTE Assessment)	Form	Modified
211278	Exhibit C (Resident FTE Assessment)	Form	Modified	Exhibit C (FTE Resident Assessment)
211278	Exhibit C (Resident FTE Assessment)	Form	Modified
211277	Conversation Record (Resident FTE Assessment)	Form	Modified	Conversation Record (FTE Resident Assessment)
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
211222	CFO Cover Letter (Initial and Reconciliation)	Other-no form-provided by grantee	Modified
211221	Application Cover Letter (initial and reconciliation)	Other-no form - provided by grantee	Modified
211220	HRSA 99-5 (Initial and Reconciliation)	Form	Modified	HRSA 99-5 (Initial and Reconciliation)
211220	HRSA 99-5 (Initial and Reconciliation)	Form	Modified
211219	HRSA 99-4 (Reconciliation)	Form	Modified	HRSA 99-4 (Reconciliation)
211219	HRSA 99-4 (Reconciliation)	Form	Modified
211217	HRSA 99-2 (Initial)	Form	Modified	HRSA 99-2 (Initial)
211217	HRSA 99-2 (Initial)	Form	Modified
211216	HRSA 99-1 (Initial)	Form	Modified	HRSA 99-1 (Initial)
211216	HRSA 99-1 (Initial)	Form	Modified
211215	HRSA 99 (Initial and Reconcilation)	Form	Modified	HRSA 99 (Initial and Reconciliation)
211215	HRSA 99 (Initial and Reconcilation)	Form	Modified

ICR Details

OMB Control No: 0915-0247	ICR Reference No: 202509-0915-004
Status: Active	Previous ICR Reference No: 202210-0915-007
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Children's Hospital Graduate Medical Education Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/22/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2028	36 Months From Approved	12/31/2025
Responses	2,640	0	2,640
Time Burden (Hours)	9,980	0	9,880
Cost Burden (Dollars)	0	0	0

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Abstract: The Children’s Hospitals Graduate Medical Education (CHGME) Payment Program provides Federal support for graduate medical education to freestanding children’s hospitals. Eligible children’s hospitals receive payments for both direct and indirect medical education. Data based on the number of FTE residents trained in applicant children’s hospital and teaching health center training programs is needed to determine the amount of graduate medical education payments to be distributed to participating children’s hospitals and teaching health centers. Children’s hospitals and teaching health centers applying for and receiving CHGME Payment Program and THCGME Program funds and fiscal intermediaries auditing data submitted by the participating children’s hospitals and teaching health centers are the anticipated respondents. If this data is not collected, HRSA will have no means to monitor grantees, verify grantee reporting, or determine grantee eligibility for CHGME funding.

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Authorizing Statute(s): PL: Pub.L. 115 - 241 340E Name of Law: CHGME Support Reauthorization Act of 2013
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 22496	05/28/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 46612	09/29/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 29

table that charts list of burden

IC Title	Form No.	Form Name
Application Cover Letter (initial and reconciliation)
CFO Cover Letter (Initial and Reconciliation)
Conversation Record (Resident FTE Assessment)	CR	Conversation Record (FTE Resident Assessment)
Exhibit 1 (Resident FTE Assessment)
Exhibit 2 (FTE Resident Assessment)
Exhibit 2 (Initial and Reconciliation)
Exhibit 3 (FTE Resident Assessment)
Exhibit 3 (Initial and Reconciliation)
Exhibit 4 (FTE Resident Assessment)
Exhibit 4 (Initial and Reconciliation)
Exhibit C (Resident FTE Assessment)	C	Exhibit C (FTE Resident Assessment)
Exhibit E (Fiscal Intermediary Introductory Request Letter)
Exhibit F (Resident FTE Assessment)
Exhibit N (Resident FTE Assessment)	N	Exhibit N (FTE Resident Assessment)
Exhibit O(1) (Resident FTE Assessment)	O(1)	Exhibit O(1) (FTE Resident Assessment)
Exhibit O(2) (Resident FTE Assessment)	O2	Exhibit O(2) (FTE Resident Assessment)
Exhibit P (Resident FTE Assessment)	P	Exhibit P (FTE Resident Assessment)
Exhibit P(2) (FTE Resident Assessment)
Exhibit S (Resident FTE Assessment)	S	Exhibit S (FTE Resident Assessment)
Exhibit T (Resident FTE Assessment)
Exhibit T(1) (Resident FTE Assessment)
HRSA 99 (Initial and Reconcilation)	99 I and R	HRSA 99 (Initial and Reconciliation)
HRSA 99-1 (Initial)	99-1	HRSA 99-1 (Initial)
HRSA 99-1 (Reconcilliation)	99-1 R	HRSA 99-1 (Reconciliation)
HRSA 99-1 Supplemental (FTE Resident Assessment)	99-1 S	HRSA 99-1 (Supplemental FTE Resident Assessment)
HRSA 99-2 (Initial)	99-2 I	HRSA 99-2 (Initial)
HRSA 99-2 (Reconcilliation)	99-2 R	HRSA 99-2 (Reconciliation)
HRSA 99-4 (Reconciliation)	99-4 R	HRSA 99-4 (Reconciliation)
HRSA 99-5 (Initial and Reconciliation)	99-5 I & R	HRSA 99-5 (Initial and Reconciliation)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,640	2,640	0	0	0	0
Annual Time Burden (Hours)	9,980	9,880	0	100	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The current burden in this collection is 9,880, and the burden in the last approved collection was 9,980. There was an increase in the burden for HRSA 99-2 (Initial) because the average burden per response went up from 9.67 hours to 11.33 hours. In June 2025, seven (7) CHGME Payment Program participating children’s hospitals and CHGME Payment Program and THCGME Program contracted fiscal intermediaries (auditors) reviewed the CHGME and THCGME materials for the burden estimate and for the clarity of instructions and forms. Based on their feedback, the total 9,980.40 burden hours for all forms and exhibits have not changed from the burden hours provided in the published 60-day FRN.

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Annual Cost to Federal Government: $698,577

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/30/2025

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