Children's Hospital Graduate Medical Education Program

ICR 202509-0915-004

OMB: 0915-0247

Federal Form Document

IC Document Collections
IC ID
Document
Title
Status
256635 Modified
237997 Modified
237996 Modified
237995 Modified
237994 Modified
237991 Modified
224952 Modified
224950 Modified
211283 Modified
211282 Modified
211281 Modified
211280 Modified
211279 Modified
211278 Modified
211277 Modified
211276 Modified
211275 Modified
211274 Modified
211273 Modified
211272 Modified
211270 Modified
211269 Modified
211222 Modified
211221 Modified
211220 Modified
211219 Modified
211217 Modified
211216 Modified
211215 Modified
ICR Details
0915-0247 202509-0915-004
Received in OIRA 202210-0915-007
HHS/HSA
Children's Hospital Graduate Medical Education Program
Revision of a currently approved collection   No
Regular 09/30/2025
  Requested Previously Approved
36 Months From Approved 12/31/2025
2,640 2,640
9,980 9,880
0 0

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.

PL: Pub.L. 115 - 241 340E Name of Law: CHGME Support Reauthorization Act of 2013
  
None

Not associated with rulemaking

  90 FR 22496 05/28/2025
90 FR 46612 09/29/2025
Yes

29
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)

  Total Request 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
Yes
Miscellaneous Actions
No
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.

$698,577
No
    Yes
    Yes
No
No
No
No
Laura Cooper 301 443-2126 lcooper@hrsa.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/30/2025


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