Performance Improvement Measurement System for the Office for the Advancement of Telehealth, Telehealth Resource Center Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 TRC Performance Indicator Data Collection Tool	Form and Instruction	Modified	Available
Form 1 TRC Performance Indicator Data Collection Tool	Form and Instruction	Modified	Repair queued
Comment 1_Public_07202025.pdf	Public Comments	Uploaded 2025-07-20	Available
Supporting Statement A TRC draft 07222025.docx	Supporting Statement A	Uploaded 2025-07-22	Available
Supporting Statement A TRC draft 07222025.docx	Supporting Statement A	Uploaded 2025-07-22	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205420	TRC Performance Indicator Data Collection Tool	Form and Instruction	Modified	TRC Performance Indicator Data Collection Tool
205420	TRC Performance Indicator Data Collection Tool	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0361	ICR Reference No: 202507-0915-002
Status: Active	Previous ICR Reference No: 202205-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Performance Improvement Measurement System for the Office for the Advancement of Telehealth, Telehealth Resource Center Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/12/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/23/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2028	36 Months From Approved	09/30/2025
Responses	588	0	588
Time Burden (Hours)	41	0	41
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA requests a revision of its approved Telehealth Resource Center (TRC) Performance Measurement Tool and renewal of the previously approved performance measures. TRCs deliver telehealth technical assistance under cooperative agreements awarded by HRSA’s Office for the Advancement of Telehealth, as authorized by section 330I(d)(2) of the Public Health Service Act (42 U.S.C. § 254c-14(d)(2)). There are two types of HRSA TRC programs: Two National TRC Programs focus on policy and technology, Twelve Regional TRC Programs host activities and provide resources to rural and underserved areas. HRSA TRCs: provide training and support, publicize information and research findings, support collaboration and partnerships, promote effective partnerships, and promote the use of telehealth by providing health care information and education to the public and medical specialists. TRCs share expertise through individual consults, training, webinars, conference presentations, and the web. HRSA collects information using the TRC Performance Measurement Tool. HRSA seeks to revise its approved information collection because the electronic system for submitting information to HRSA has changed from the Performance Improvement Management System to Data Collection Platform as a Service (DCP). Although the electronic system has changed, the information collected using the TRC Performance Measurement Tool has not changed and HRSA’s burden estimate remains the same.

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Authorizing Statute(s): PL: Pub.L. 107 - 251 330I(d)(2) Name of Law: Health Care Safety Net Amendments of 2002
   US Code: 42 USC 254c-14(d)(2) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 20677	05/15/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 33962	07/18/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
TRC Performance Indicator Data Collection Tool	1	TRC Performance Indicator Data Collection Tool

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	588	588	0	0	0	0
Annual Time Burden (Hours)	41	41	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $62,573

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/23/2025

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