Information Collection

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

IC 180666 under ICR 202008-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
OAT PIMS Instructions.docx	Instruction
1 PIMS Measures FINALPIMS measures july2020-revisions highlighted8.12.20.docx	Form
2 Tele-Emergency Measures Tele-Emergency measures july2020.pdf	Form

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	PIMS Measures	FINALPIMS measures july2020-revisions highlighted8.12.20.docx	Yes	No	Fillable Fileable
Form	2	Tele-Emergency Measures	Tele-Emergency measures july2020.pdf	Yes	Yes	Fillable Fileable
Instruction			OAT PIMS Instructions.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 29

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	29	8	21
Annual IC Time Burden (Hours)	203	56	147
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.