Collection of Qualitative Feedback on Telehealth.HHS.gov

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

OMB: 0915-0212

IC ID: 248260

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Collection of Qualitative Feedback on Telehealth.HHS.gov
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Telehealth Website - Page Level - SurveyEngSpan.docx Telehealth Website - Page Level - SurveyEngSpan.docx Yes Yes Fillable Fileable
Form 2 Telehealth Website - Site Level - Survey EngSpan.docx Telehealth Website - Site Level - Survey EngSpan.docx Yes Yes Fillable Fileable

Health Health Care Services

 

17,465 0
   
Individuals or Households
 
   100 %

  Requested 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 17,465 0 0 0 0 17,465
Annual IC Time Burden (Hours) 99 0 0 0 0 99
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Telehealth Website - GENERIC - Supporting Statement FINAL JULY 7 Telehealth Website - GENERIC - Supporting Statement FINAL JULY 7.docx 07/07/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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