Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application Cover Letter New 120 40 0 Instruction
CFO Cover Letter New 120 40 0 Instruction
Children's Hospital Graduate Medical Eduction Payment Program Removed 0 0 0 Form and Instruction 1-2 HRSA_CHGME_99-1-2
Form and Instruction 4 HRSA_CHGME_99-4
Form and Instruction HRSA_CHGME_99 HRSA_CHGME_99
Form and Instruction HRSA_CHGME_99-3 HRSA_CHGME_99-3
Form and Instruction HRSA_CHGME_99-5 HRSA_CHGME_99-5
Conversation Record (Resident FTE Assessment) New 30 110 0 Form Conversation Record (Resident FTE Assessment) Conversation Record (Resident FTE Assessment)
Exhibit 1 (Resident FTE Assessment) New 30 10 0 Instruction
Exhibit 2 (Initial, Resident FTE Assessment, Reconciliation) New 90 30 0 Instruction
Exhibit 3 (Initial, Resident FTE Assessment, Reconciliation) New 90 30 0 Instruction
Exhibit 4 (Initial, Resident FTE Assessment, Reconciliation) New 90 30 0 Instruction
Exhibit C (Resident FTE Assessment) New 30 110 0 Form Exhibit C (Resident FTE Assessment) Exhibit C (Resident FTE Assessment)
Exhibit F (Resident FTE Assessment) New 30 110 0 Instruction
Exhibit N (Resident FTE Assessment) New 30 110 0 Form Exhibit N (Resident FTE Assessment) Exhibit N (Resident FTE Assessment)
Exhibit O(1) (Resident FTE Assessment) New 30 110 0 Form Exhibit O(1) (Resident FTE Assessment) Exhibit O(1) (Resident FTE Assessment)
Exhibit O(2) (Resident FTE Assessment) New 30 795 0 Form Exhibit O(2) (Resident FTE Assessment) Exhibit O(2) (Resident FTE Assessment)
Exhibit P (Resident FTE Assessment) New 30 110 0 Form Exhibit P (Resident FTE Assessment) Exhibit P (Resident FTE Assessment)
Exhibit P(2) (Resident FTE Assessment) New 30 110 0 Instruction
Exhibit S (Resident FTE Assessment) New 30 110 0 Form Exhibit S (Resident FTE Assessment) Exhibit S (Resident FTE Assessment)
Exhibit T (Resident FTE Assessment) New 30 110 0 Instruction
Exhibit T(1) (Resident FTE Assessment) New 30 110 0 Instruction
FTE Assessment Letter (Resident FTE Assessment) New 30 10 0 Instruction
HRSA 99 New 120 40 0 Form 99 HRSA 99
HRSA 99-1 New 150 2090 0 Form HRSA 99-1 HRSA 99-1
HRSA 99-2 New 120 900 0 Form HRSA 99-2 HRSA 99-2
HRSA 99-4 New 60 750 0 Form HRSA 99-4 HRSA 99-4
HRSA 99-5 New 120 40 0 Form HRSA 99-5 HRSA 99-5
Total burden requested under this ICR: 1470 5905 0  
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