Information Collection

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

IC 180666 under ICR 201811-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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
0915-0311 PBS screenshots.docx PBS Screenshots IC Document

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Asthma	SB TNGP - DED - Module for Asthma.docx	Yes	No	Fillable Printable
Form	2	Behavioral Health	SB TNGP - DED - Module for Behavioral Health.docx	Yes	No	Fillable Printable
Form	3	Diabetes	SB TNGP - DED - diabetes - OMB documentation.docx	Yes	No	Fillable Printable
Form	4	Healthy Weight	SB TNGP - DED - Module for Healthy Weight.docx	Yes	No	Fillable Printable
Form	5	Oral Health	SB TNGP - DED - Module for Oral Health.docx	Yes	No	Fillable Printable
Form	6	School Level	SB TNGP - DED - School Level.docx	Yes	No	Fillable Printable
Form	7	Student Level	SB TNGP - DED - Student Level.docx	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	21	21
Annual IC Time Burden (Hours)	147	147
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OAT Grantee Tutorial	OAT Grantee Tutorial for PIMS login.pdf	06/13/2018
RTRC Measures	RTRC measures.pdf	06/13/2018
TNGP PIMS Manual	TNGP PIMS manual.pdf	06/13/2018
TNGP PIMS Instructions	TNGP PIMS measures instructions.docx	06/13/2018
PBS Screenshots	0915-0311 PBS screenshots.docx	11/02/2018

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