OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Collection of Qualitative Feedback on Telehealth.HHS.gov

IC 265626 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Collection of Qualitative Feedback on Telehealth.HHS.gov
 
Unchanged
 
Voluntary
 

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

Health Health Care Services

 

6,600 0
   
Individuals or Households
 
   100 %

  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 6,600 0 0 0 0 6,600
Annual IC Time Burden (Hours) 48 0 0 0 0 48
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.