Collection of Qualitative Feedback on Telehealth.HHS.gov

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

⚠️ Notice: This information collection may be referencing outdated material.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
1 Website user (page-level survey) Telehealth Website - Page Level - SurveyEngSpan.docx Form
2 Website user (site-wide survey) Telehealth Website - Site Level - Survey EngSpan.docx Form
Public Burden Statement.docx Public Burden Statement Draft IC Document
Telehealth Website - Fast Track Memo 2.15.24 FINAL.docx Generic IC Memo IC Document

Information Collection (IC) Details

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	1	Website user (page-level survey)	Telehealth Website - Page Level - SurveyEngSpan.docx		Yes	Yes	Fillable Fileable
Form	2	Website user (site-wide survey)	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: 6,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,600	6,600
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Public Burden Statement Draft	Public Burden Statement.docx	02/26/2024
Generic IC Memo	Telehealth Website - Fast Track Memo 2.15.24 FINAL.docx	02/26/2024

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