Information Collection

Collection of Qualitative Feedback on Telehealth.HHS.gov

IC 264357 under ICR 202402-0906-004 · OMB 0906-0084.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0084 can be found here:

Documents and Forms

Document Name Document Type
Form 1 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
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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Collection of Qualitative Feedback on Telehealth.HHS.gov	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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	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

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 %

	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

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.