Office for the Advancement of Telehealth (OAT) Telehealth Outcome Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form and Instruction	Modified	Available
OAT PIMS Instructions.docx	Supplementary Document	Uploaded 2017-01-11	Available
60-day FRN 2016.9.28.16.for program review.docx	Supplementary Document	Uploaded 2016-11-04	Available
OAT Grantee Tutorial for PIMS login.pdf	Supplementary Document	Uploaded 2016-11-04	Available
Supporting Statement A OAT PASSBACK_OAT responsesJan10.doc	Supporting Statement A	Uploaded 2017-01-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
180666	Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0311	ICR Reference No: 201611-0915-001
Status: Historical Active	Previous ICR Reference No: 201312-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No: 20962
Title: Office for the Advancement of Telehealth (OAT) Telehealth Outcome Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/11/2017
	Date Received in OIRA: 11/04/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved	01/31/2017
Responses	400	0	1,400
Time Burden (Hours)	2,800	0	9,800
Cost Burden (Dollars)	0	0	0

---

Abstract: The data collection tool extracts valuable information on services provided that are critical to the mission of HRSA and provides valid and complete information about methods used to measure the impact of the telehealth program on improving access to healthcare services for residents of communities that did not have such services locally before the program. Projects are able to measure the impact of the telehealth program on hospitalization rates and emergency room visit rates per year for patients receiving disease management services for diabetes, congestive heart failure, stroke and other chronic diseases, as well for patients receiving home care/home monitoring services. Projects can measure impact of the telehealth program on controlling blood glucose levels in diabetic patients and can assure the impact of the telehealth program improving efficiency of health care. In addition, projects also measure the impact of the telehealth program on reducing medical errors and collect data to measure other clear outcomes.

---

Authorizing Statute(s): PL: Pub.L. 107 - 251 3301 Name of Law: Public Health Service Act, Health Care Safety Net Amendments
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 52880	08/10/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 76363	11/02/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Performance Improvement Measurement System for the Office for the Advancement of Telehealth	1	NEWFY16 TNGP measures_FINAL_June2016.docx

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	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	400	1,400	0	-1,000	0	0
Annual Time Burden (Hours)	2,800	9,800	0	-7,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The OAT PIMS tool is fully electronic within HRSA’s Electronic Handbook. The system design provides pre-formatted and interactive data entry that helps assure standardized data across the Telehealth Network Grant Programs and greatly simplifies the data entry process.

---

Annual Cost to Federal Government: $63,821

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/04/2016

---