OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Evidence Based Telehealth Network Program Report

IC 237633 under ICR 202311-0906-001 · OMB 0906-0043.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Other-Supplemental
Other-Supplemental
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Evidence Based Telehealth Network Program Report
 
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 and Instruction 1 RTRC Data Element Dictionary RTRC Data Element Dictionary for EB TNP Data Collection - 10.20.2023.pdf Yes Yes Fillable Fileable
Instruction RTRC Study Protocol for EB TNP Data Collection - 10.20.2023.pdf Yes Yes Fillable Fileable
Other-Supplemental D-TEC Tool RedCap Screenshots 10.20.2023.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

11 0
   
Private Sector Not-for-profit institutions
 
   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 44 0 -124 0 0 168
Annual IC Time Burden (Hours) 1,364 0 -484 0 0 1,848
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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