TRC Performance Indicator Data Collection Tool

Telehealth Resource Center Grant Program Performance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0361 can be found here:

Documents and Forms

Document Name Document Type
Form 1 TRC Performance Indicator Data Collection Tool Form and Instruction
1 TRC Performance Indicatator Data Collection Tool TRC Performance Indicatator Data Collection Tool.docx Form and Instruction

Information Collection (IC) Details

IC Title:	TRC Performance Indicator Data Collection Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	TRC Performance Indicatator Data Collection Tool	TRC Performance Indicatator Data Collection Tool.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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
Annual Number of Responses for this IC	760	760
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	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.