Information Collection

Telehealth Remote Patient Monitoring

IC 277578 under ICR 202503-2900-010 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2900-0876 Teleheal 2900-0876 Telehealth Remote Patient Monitoring Telehealth Remote Patient Monitoring	Form and Instruction
2900-0876 Teleheal 2900-0876 Telehealth Remote Patient Monitoring Wireframe Remote Patient Monitoring - Home Telehealth New.docx	Form and Instruction
A11 Fast-Track Clarance Request Template_Telehealth RPM-HT.docx Telehealth Remote Patient Monitoring	IC Document

IC Title:

Telehealth Remote Patient Monitoring

Agency IC Tracking Number:

2900-0876 Telehealth Remote Patient Monitoring

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 and Instruction	2900-0876 Telehealth Remote Patient Monitoring				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Department of Veterans Affairs (VA)

FR Citation: 86 FR 6992

Number of Respondents: 50,000

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	50,000	50,000
Annual IC Time Burden (Hours)	3,333	3,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Telehealth Remote Patient Monitoring		09/16/2025

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

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