View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Telemedicine Survey	Agency IC Tracking Number:	2900-0876Telemedicine

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Telemedicine: Telehealth Appointment Scheduling	Telemedicine: Telehealth Appointment Scheduling	Telehealth Appointment Scheduling Survey 20220114.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 604,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	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	604,800	0	604,800	0	0	0
Annual IC Time Burden (Hours)	30,240	0	30,240	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
A-11 Fast Track Clearance Request Template_Telemedicine	A-11 Fast Track Clearance Request Template_Telemedicine.pdf	02/02/2022

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