OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Children's Hospital Graduate Medical Education Program

OMB 0915-0247 · HHS/HSA.

OMB 0915-0247

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.

The latest form for Children's Hospital Graduate Medical Education Program expires 2028-12-31 and is listed under ICR 202509-0915-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 99-2 R HRSA 99-2 (Reconciliation)Form
Form 99-2 R HRSA 99-2 (Reconcilliation)Form
Form 99-1 S HRSA 99-1 (Supplemental FTE Resident Assessment)Form
Form 99-1 S HRSA 99-1 Supplemental (FTE Resident Assessment)Form
Form 99-1 R HRSA 99-1 (Reconciliation)Form
Form 99-1 R HRSA 99-1 (Reconcilliation)Form
Form S Exhibit S (FTE Resident Assessment)Form
Form S Exhibit S (Resident FTE Assessment)Form
Form P Exhibit P (FTE Resident Assessment)Form
Form P Exhibit P (Resident FTE Assessment)Form
Form O2 Exhibit O(2) (FTE Resident Assessment)Form
Form O2 Exhibit O(2) (Resident FTE Assessment)Form
Form O(1) Exhibit O(1) (FTE Resident Assessment)Form
Form O(1) Exhibit O(1) (Resident FTE Assessment)Form
Form N Exhibit N (FTE Resident Assessment)Form
Form N Exhibit N (Resident FTE Assessment)Form
Form C Exhibit C (FTE Resident Assessment)Form
Form C Exhibit C (Resident FTE Assessment)Form
Form CR Conversation Record (FTE Resident Assessment)Form
Form CR Conversation Record (Resident FTE Assessment)Form
Form 99-5 I & R HRSA 99-5 (Initial and Reconciliation)Form
Form 99-5 I & R HRSA 99-5 (Initial and Reconciliation)Form
Form 99-4 R HRSA 99-4 (Reconciliation)Form
Form 99-4 R HRSA 99-4 (Reconciliation)Form
Form 99-2 I HRSA 99-2 (Initial)Form
Form 99-2 I HRSA 99-2 (Initial)Form
Form 99-1 HRSA 99-1 (Initial)Form
Form 99-1 HRSA 99-1 (Initial)Form
Form 99 I and R HRSA 99 (Initial and Reconciliation)Form
Form 99 I and R HRSA 99 (Initial and Reconcilation)Form
Comment 2_Kaplan Transmittal 07252025.pdf (document unavailable)Public Comments
Comment 2_Kaplan 07252025.pdfPublic Comments
Comment 1_McNaus Transmittal 07252025.pdfPublic Comments
Comment 1_McNaus 07252025.pdf (document unavailable)Public Comments
CHGME-ApplicationGuidance- 06.26.24 FINAL.pdfSupplementary Document
CHGME-ApplicationGuidance- 06.26.24 FINAL.pdf Supplementary Document
GMEs FTE Resident Assessment - SS-A 0915-0247 09112025.docxSupporting Statement A
GMEs FTE Resident Assessment - SS-A 0915-0247 09112025.docxSupporting Statement A
Exhibit E (Fiscal Intermediary Introductory Request Letter) Other-no form-provided by grantee
Exhibit 4 (FTE Resident Assessment) Other-no form-provided by grantee
Exhibit 3 (FTE Resident Assessment) Other-no form-provided by grantee
Exhibit 2 (FTE Resident Assessment) Other-no form-provided by grantee
Exhibit P(2) (FTE Resident Assessment) Other-no form-provided by grantee
HRSA 99-2 (Reconcilliation) Form
HRSA 99-2 (Reconcilliation) Form
HRSA 99-1 Supplemental (FTE Resident Assessment) Form
HRSA 99-1 Supplemental (FTE Resident Assessment) Form
HRSA 99-1 (Reconcilliation) Form
HRSA 99-1 (Reconcilliation) Form
Exhibit S (Resident FTE Assessment) Form
Exhibit S (Resident FTE Assessment) Form
Exhibit P (Resident FTE Assessment) Form
Exhibit P (Resident FTE Assessment) Form
Exhibit O(2) (Resident FTE Assessment) Form
Exhibit O(2) (Resident FTE Assessment) Form
Exhibit O(1) (Resident FTE Assessment) Form
Exhibit O(1) (Resident FTE Assessment) Form
Exhibit N (Resident FTE Assessment) Form
Exhibit N (Resident FTE Assessment) Form
Exhibit C (Resident FTE Assessment) Form
Exhibit C (Resident FTE Assessment) Form
Conversation Record (Resident FTE Assessment) Form
Conversation Record (Resident FTE Assessment) Form
Exhibit 1 (Resident FTE Assessment) Other-no form-provided by grantee
Exhibit 2 (Initial and Reconciliation) Other-no form-provided by grantee
Exhibit 3 (Initial and Reconciliation) Other-no form-provided by grantee
Exhibit 4 (Initial and Reconciliation) Other-no form-provided by grantee
Exhibit F (Resident FTE Assessment) Other-no form-provided by grantee
Exhibit T (Resident FTE Assessment) Other-no form-provided by grantee
Exhibit T(1) (Resident FTE Assessment) Other-no form-provided by grantee
CFO Cover Letter (Initial and Reconciliation) Other-no form-provided by grantee
Application Cover Letter (initial and reconciliation) Other-no form - provided by grantee
HRSA 99-5 (Initial and Reconciliation) Form
HRSA 99-5 (Initial and Reconciliation) Form
HRSA 99-4 (Reconciliation) Form
HRSA 99-4 (Reconciliation) Form
HRSA 99-2 (Initial) Form
HRSA 99-2 (Initial) Form
HRSA 99-1 (Initial) Form
HRSA 99-1 (Initial) Form
HRSA 99 (Initial and Reconcilation) Form
HRSA 99 (Initial and Reconcilation) Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202509-0915-004 Revision of a currently approved collection 2025-09-30
202210-0915-007 Revision of a currently approved collection 2022-11-02 Approved with change
201910-0915-001 Revision of a currently approved collection 2019-10-07 Approved with change
201612-0915-004 Revision of a currently approved collection 2016-12-23 Approved without change
201404-0915-005 Revision of a currently approved collection 2014-04-23 Approved with change
201103-0915-001 Revision of a currently approved collection 2011-03-22 Approved with change
201002-0915-002 Extension without change of a currently approved collection 2010-02-22 Approved with change
200701-0915-003 Revision of a currently approved collection 2007-01-17 Approved with change
200312-0915-002 Revision of a currently approved collection 2003-12-12 Approved without change
200202-0915-002 Revision of a currently approved collection 2002-02-14 Approved with change
200011-0915-003 Revision of a currently approved collection 2000-11-16 Approved without change
200005-0915-004 New collection (Request for a new OMB Control Number) 2000-05-17 Approved without change

OMB Details

HRSA 99 (Initial and Reconcilation)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form 99 I and RHRSA 99 (Initial and Reconciliation)Fillable FileableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.