Telehealth Performance Measurement Report

Evidence Based Telehealth Network Program Measures

OMB: 0906-0043

IC ID: 237634

Information Collection (IC) Details

View Information Collection (IC)

Telehealth Performance Measurement Report
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Evidence-Based Telehealth Network Program_Data Dictionary EB-TNP-PIMS-Data-Dictionary Clean.pdf Yes Yes Fillable Fileable
Form and Instruction 1.1 EP TNP PIMS Template EB TNP PIMS Clean Template Pending OMB Approval 10.20.2023.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

11 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11 0 -3 0 0 14
Annual IC Time Burden (Hours) 55 0 -15 0 0 70
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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