Information Collection

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

IC 180666 under ICR 201806-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Asthma Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form
Form 2 Behavioral Health Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form
Form 3 Diabetes Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form
Form 4 Healthy Weight Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form
Form 5 Oral Health Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form
Form 6 School Level Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form
Form 7 Student Level Performance Improvement Measurement System for the Office for the Advancement of Telehealth	Form
1 Asthma SB TNGP - DED - Module for Asthma.docx	Form
2 Behavioral Health SB TNGP - DED - Module for Behavioral Health.docx	Form
3 Diabetes SB TNGP - DED - diabetes - OMB documentation.docx	Form
4 Healthy Weight SB TNGP - DED - Module for Healthy Weight.docx	Form
5 Oral Health SB TNGP - DED - Module for Oral Health.docx	Form
6 School Level SB TNGP - DED - School Level.docx	Form
7 Student Level SB TNGP - DED - Student Level.docx	Form
OAT Grantee Tutorial for PIMS login.pdf OAT Grantee Tutorial	IC Document
RTRC measures.pdf RTRC Measures	IC Document
TNGP PIMS manual.pdf TNGP PIMS Manual	IC Document
TNGP PIMS measures instructions.docx TNGP PIMS Instructions	IC Document

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Yes	No	Fillable Printable
Form	2	Yes	No	Fillable Printable
Form	3	Yes	No	Fillable Printable
Form	4	Yes	No	Fillable Printable
Form	5	Yes	No	Fillable Printable
Form	6	Yes	No	Fillable Printable
Form	7	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 21

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	21	-379	400
Annual IC Time Burden (Hours)	147	-2,653	2,800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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