View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Telehealth Emergency Medicine Survey Update	Agency IC Tracking Number:	2900-0876

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	Telehealth Emergency Medicine Survey Update WF	Telehealth Emergency Medicine Survey Update WF	Telehealth Emergency Medicine Survey Update WF.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Veterans, Dependents of Veterans, and Veteran Beneficiaries Survey Records	FR Citation: 86 FR 6992

Number of Respondents: 9,900	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	9,900	0	9,900	0	0	0
Annual IC Time Burden (Hours)	495	0	495	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Telehealth Emergency Medicine Survey Update - signed by LD.pdf	Telehealth Emergency Medicine Survey Update - signed by LD.pdf	04/04/2025
ICR Template_A11 Section 280 Clearance Telehealth Emergency Medicine Survey Update	ICR Template_A11 Section 280 Clearance Telehealth Emergency Medicine Survey Update.docx	04/22/2025

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