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Annual Grantee Performance Report - THGP
Telehealth Grant Program (THGP) - AS20
OMB:
IC ID: 271213
OMB.report
VA
ICR 202409-2900-010
IC 271213
( )
Documents and Forms
Document Name
Document Type
Form 10-397
Annual Grantee Performance Report - THGP
Form
10-397 Annual Grantee Performance Report
Annual Grantee Performance Report_Telehealth Grant Program_draft.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Annual Grantee Performance Report - THGP
Agency IC Tracking Number:
VHA-2900-NEW
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
10-397
Annual Grantee Performance Report
Annual Grantee Performance Report_Telehealth Grant Program_draft.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
34VA12
FR Citation:
86 FR 33015
Number of Respondents:
50
Number of Respondents for Small Entity:
50
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
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
50
0
50
0
0
0
Annual IC Time Burden (Hours)
38
0
38
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
