Information Collection

Collection of Qualitative Feedback on Telehealth.HHS.gov

IC 265626 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.