Evidence Based Telehealth Network Program Report

Evidence Based Telehealth Network Program Measures

Documents and Forms

Document Name Document Type
Form 1 Evidence Based Telehealth Network Program Report Form and Instruction
RTRC Study Protocol for EB TNP Data Collection - 10.20.2023.pdf Instruction
RTRC Study Protocol for EB TNP Data Collection - 10.20.2023.pdf Instruction
D-TEC Tool RedCap Screenshots 10.20.2023.pdf Other-Supplemental
D-TEC Tool RedCap Screenshots 10.20.2023.pdf Other-Supplemental
1 RTRC Data Element Dictionary RTRC Data Element Dictionary for EB TNP Data Collection - 10.20.2023.pdf Form and Instruction
1 RTRC Data Element Dictionary RTRC Data Element Dictionary for EB TNP Data Collection - 10.20.2023.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Evidence Based Telehealth Network Program Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	RTRC Data Element Dictionary	RTRC Data Element Dictionary for EB TNP Data Collection - 10.20.2023.pdf	Yes	Yes	Fillable Fileable
Instruction			RTRC Study Protocol for EB TNP Data Collection - 10.20.2023.pdf	Yes	Yes	Fillable Fileable
Other-Supplemental			D-TEC Tool RedCap Screenshots 10.20.2023.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	44	-124	168
Annual IC Time Burden (Hours)	1,364	-484	1,848
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.