Evidence Based Telehealth Network Program Measures

OMB 0906-0043

The purpose of these programs are to provide grants that demonstrate how telehealth programs and networks can improve access to quality health care services in rural and frontier communities. The measures will enable FORHP to capture awardee-level data that illustrates the impact and scope of federal funding along with evaluating these efforts. The respondents would be award recipients of the Evidence Based Telehealth Network Program.

The latest form for Evidence Based Telehealth Network Program Measures expires 2022-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 Telehealth Performance Measurement Report Form and Instruction
Form 1 Evidence Based Telehealth Network Program Report Form and Instruction
11.14.2023 Supporting Statement A FINAL.docx Supporting Statement A
Telehealth Performance Measurement Report Form and Instruction
Evidence Based Telehealth Network Program Report Form and Instruction

All Historical Document Collections

202311-0906-001 Approved without change	Revision of a currently approved collection	2023-11-29
202301-0906-002 Approved without change	Reinstatement without change of a previously approved collection	2023-01-11
201909-0906-001 Approved with change	New collection (Request for a new OMB Control Number)	2019-09-04

OMB Details

Evidence Based Telehealth Network Program Report

Federal Enterprise Architecture: Health - Health Care Services

Form 1	CORRECTED PDF - FORM Evidence Based Telehealth Network Program Report	Fillable Fileable	Form
Form 1	Evidence Based Telehealth Network Program Report.pdf	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.