Performance Improvement Measurement System for the Office for the Advancement of Telehealth, Telehealth Resource Center Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form D TRC Performance Indicator Data Collection Tool	Form and Instruction	Modified	Available
AttachC_PIMS Instructions_TRC.docx	Supplementary Document	Uploaded 2019-02-19	Available
ATTACHB60 day FRN 0361 TRCGP.pdf	Supplementary Document	Uploaded 2019-02-19	Available
AttachAMeasure Changes_2018.docx	Supplementary Document	Uploaded 2019-02-19	Available
CleanFINALSupporting Statement A-TRC 2018_Revised_Mar2019_v2.docx	Supporting Statement A	Uploaded 2019-04-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205420	TRC Performance Indicator Data Collection Tool	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0361	ICR Reference No: 201902-0915-002
Status: Active	Previous ICR Reference No: 201603-0915-006
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Performance Improvement Measurement System for the Office for the Advancement of Telehealth, Telehealth Resource Center Program
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: 04/09/2019
	Date Received in OIRA: 02/20/2019
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time HRSA will request approval to extend or revise the collection if HRSA seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2022	36 Months From Approved	06/30/2019
Responses	588	0	588
Time Burden (Hours)	41	0	41
Cost Burden (Dollars)	0	0	0

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Abstract: To ensure the best use of public funds and to meet the Government Performance Review Act requirements, the Federal Office of Rural Health’s Office for the Advancement of Telehealth (OAT) in collaboration with the Telehealth Resource Centers (TRCs) created a set of performance measures that grantees can use to evaluate the technical assistance services provided by the TRCs. Grantee goals are to customize the provision of telehealth technical assistance across the country. The TRCs provide technical assistance to health care organizations, health care networks and health care providers in the implementation of cost-effective telehealth programs to serve rural and medically underserved areas and populations

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Authorizing Statute(s): US Code: 42 USC 254c-14(d)(2) Name of Law: Public Health Service Act
   PL: Pub.L. 107 - 251 330I(d)(2) Name of Law: Health Care Safety Net Amendments of 2002
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 15164	04/09/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 1749	02/05/2019
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
TRC Performance Indicator Data Collection Tool	D	TRC Performance Indicator Data Collection Tool

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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	588	588	0	0	0	0
Annual Time Burden (Hours)	41	41	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $53,602

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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Common Form ICR:  No

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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: 02/20/2019

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