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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.