Information Collection

Collection of Qualitative Feedback on Telehealth.HHS.gov

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction
Form 1 Telehealth Website - Page Level - SurveyEngSpan Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction
Form 2 Telehealth Website - Site Level - Survey EngSpan Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction
1 Telehealth Website - Page Level - SurveyEngSpan Telehealth Website - Page Level - SurveyEngSpan.docx	Form and Instruction
1 Telehealth Website - Page Level - SurveyEngSpan Telehealth Website - Page Level - SurveyEngSpan.docx	Form and Instruction
2 Telehealth Website - Site Level - Survey EngSpan Telehealth Website - Site Level - Survey EngSpan.docx	Form and Instruction
2 Telehealth Website - Site Level - Survey EngSpan Telehealth Website - Site Level - Survey EngSpan.docx	Form and Instruction
Telehealth Website - GENERIC - Supporting Statement FIN.docx Original Generic Request	IC Document
Telehealth Website - GENERIC - Supporting Statement FIN.docx Original Generic Request	IC Document

IC Title:

Agency IC Tracking Number:

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	1				Yes	Yes	Fillable Fileable
Form and Instruction	2				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,465

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17,465	17,465
Annual IC Time Burden (Hours)	99	99
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Original Generic Request		01/09/2024

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

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