Telehealth ATLAS VSignals Survey

Clearance for A-11 Section 280 Improving Customer Experience Information Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Document Name Document Type
Form 2900-0876-ATLAS Su Telehealth ATLAS VSignals Survey Form and Instruction
2900-0876-ATLAS Su 2900-0876-ATLAS Survey Wireframes TelehealthATLAS Survey V5 20210908.pdf Form and Instruction
A-11 Fast-Track Clearance Request Template_Telehealth ATLAS Survey.pdf Information Collection Request IC Document

Information Collection (IC) Details

IC Title:	Telehealth ATLAS VSignals Survey	Agency IC Tracking Number:	2900-0876-ATLAS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2900-0876-ATLAS Survey Wireframes	2900-0876-ATLAS Survey Wireframes	TelehealthATLAS Survey V5 20210908.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Information Collection Request	A-11 Fast-Track Clearance Request Template_Telehealth ATLAS Survey.pdf	09/13/2021

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