Evidence Based Telehealth Network Program Report

Evidence Based Telehealth Network Program Measures

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0043 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Evidence Based Telehealth Network Program Report Form and Instruction
1 RTRC Data Element Dictionary EB THNP SAT TNGP - Data Element Dictionary.pdf Form and Instruction
1 RTRC Data Element Dictionary EB THNP SAT TNGP - Data Element Dictionary.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Evidence Based Telehealth Network Program Report	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	RTRC Data Element Dictionary	EB THNP SAT TNGP - Data Element Dictionary.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	168	168
Annual IC Time Burden (Hours)	1,848	1,848
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.