Information Collection

Performance Improvement Measurement System for the Office for the Advancement of Telehealth

IC 180666 under ICR 201611-0915-001 · OMB 0915-0311.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0311 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Performance Improvement Measurement System for the Office for the Advancement of Telehealth Form and Instruction
OAT PIMS Instructions.docx Instruction
1 NEWFY16 TNGP measures_FINAL_June2016.docx NEWFY16 TNGP measures_FINAL_June2016.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Performance Improvement Measurement System for the Office for the Advancement of Telehealth	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	NEWFY16 TNGP measures_FINAL_June2016.docx	NEWFY16 TNGP measures_FINAL_June2016.docx		Yes	Yes	Fillable Fileable
Instruction			OAT PIMS Instructions.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	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	400	-1,000	1,400
Annual IC Time Burden (Hours)	2,800	-7,000	9,800
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.