Information Collection

Telehealth ATLAS VSignals Survey

IC 249220 under ICR 202107-2900-011 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.