OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Collection of Qualitative Feedback on Telehealth.HHS.gov

IC 264357 under ICR 202401-0915-004 · OMB 0915-0212.

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

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Telehealth Website - Page Level - SurveyEngSpan Telehealth Website - Page Level - SurveyEngSpan.docx Yes Yes Fillable Fileable
Form and Instruction 2 Telehealth Website - Site Level - Survey EngSpan 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 17,465 0 0 0
Annual IC Time Burden (Hours) 99 0 99 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Original Generic Request Telehealth Website - GENERIC - Supporting Statement FIN.docx 01/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.