1. (a) A copy of the application for program approval which was submitted to the Residency Review Committee of the American Medical Association or the American Osteopathic Association.
2. (b) A copy of the current program review report and letter of approval received from the Liaison Committee on Graduate Medical Education or the American Osteopathic Association.

3. (c) The budget for operation of the program for the current 12-month period, showing:

   1. (1) with respect to the total cost of the program:

      1. (i) compensation of each of the following personnel categories, both full-time and part-time: physician (excluding residents), other professional and administrative clerical;
      2. (ii) total salaries paid residents in the program;
      3. (iii) fringe benefits of all personnel. including residents;
      4. (iv) rent;
      5. (v) equipment;
      6. (vi) medical and other supplies; and
      7. (vii) all other expense items;

   2. (2) with respect to total revenues of the program, receipts or other financial support from the following resources:

      1. (i) hospital(s);
      2. (ii) third-party payors;
      3. (iii) self-pay patients;
      4. (iv) grants and contracts;
      5. (v) gifts and endowments; and
      6. (vi) other; and
   3. (3) the proposed allocation of State funding to continuation of the present program and to expansion thereof; and
4. (d) An acknowledgement that funding is contingent upon the residents' practicing medicine in New York State for at least two years following completion of their residency.

5. (e) With respect to all residents in the program:

   1. (1) the salary paid a resident in each year of the program; and

   2. (2) a list of residents, indicating name, medical school or osteopathic college of graduation, year in residency program, New York State medical license or limited permit number, or ECFMG number, and Social Security number;

      1. (i) a copy of the agreement between the program and resident wherein the resident agrees to practice medicine in New York State for at least two years following completion of the residency (hereafter the “two year service obligation agreement”.)
      2. (ii) such written agreement shall state whether the resident agrees to practice medicine in the State of New York for at least two years immediately following the completion of the family practice residency training program or immediately following completion of another medical training program or immediately following some other service obligation which the resident is legally committed to undertake. If such a commitment prevents the resident from fulfilling the two year service obligation immediately following the completion of the family practice residency training program, the agreement shall specify the date the resident expects to satisfy that commitment.

      (3)

A plan submitted to the commissioner by the program director for approval shall consist of the following: