Federal Government

Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program

OMB: 3060-1271

IC ID: 241112

Information Collection (IC) Details

View Information Collection (IC)

Federal Government WCB
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form FCC Form 460 Description of Eligibility and Registration Attachment 9 - Description of Eligibility and Registration - FCC Form 460.docx Yes Yes Fillable Fileable Signable
Other-CMHC Checklist Attachment 10 - Community Mental Health Center (CMHC) Checklist.docx Yes Yes Fillable Printable
Other-Post Commitment Request Form Attachment 11 - Post-Commitment Request Form (004) 8.17.docx Yes Yes Fillable Fileable Signable

Health Health Care Services

 

2,434 0
   
Federal Government
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11,541 0 2,201 0 0 9,340
Annual IC Time Burden (Hours) 66,116 0 8,340 0 0 57,776
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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