Office for the Advancement of Telehealth (OAT) Telehealth Outcome Measures

Forms and Documents

Document Name	Status
Form 1 Performance Improvement Measurement System for the Office for the Advancement of Telehealth Form	Modified
FINAL OAT Supporting Statement 0311.docx Supporting Statement A	2018-10-11

IC Document Collections

IC ID	Document Title	Status
180666	Performance Improvement Measurement System for the Office for the Advancement of Telehealth Form	Modified

ICR Details

OMB Control No: 0915-0311	ICR Reference No: 201806-0915-001
Status: Historical Active	Previous ICR Reference No: 201611-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No: 20962
Title: Office for the Advancement of Telehealth (OAT) Telehealth Outcome Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/17/2018
	Date Received in OIRA: 06/14/2018
Terms of Clearance: Agency will display the OMB Control Number, Expiration Date, and PRA Burden Statement on EHB by 11/15/18 and will supply screenshots to OIRA demonstrating compliance by that date.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2019	36 Months From Approved	01/31/2020
Responses	21	0	400
Time Burden (Hours)	147	0	2,800
Cost Burden (Dollars)	0	0	0

---

Abstract: The Telehealth Network Grant Program is authorized by Section 330I of the Public Health Service Act. The Health Care Safety Net Amendments of 2002 (Public Law 107-251) amended the Public Health Service Act by adding Section 330I. Under this authority, recipients are utilizing their established telehealth networks to expand access to priority clinical services in rural areas, particularly, rural schools. The data collected with the performance measurement tool provides HRSA’s OAT with information about outcome measures, including the effectiveness of service programs, and monitor their progress through the use of performance reporting data.

---

Authorizing Statute(s): PL: Pub.L. 107 - 251 3301 Name of Law: Public Health Service Act, Health Care Safety Net Amendments
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 1264	01/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 26063	06/05/2018
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Performance Improvement Measurement System for the Office for the Advancement of Telehealth	6, 2, 7, 1, 3, 4, 5	Asthma ,   Behavioral Health ,   Diabetes ,   Healthy Weight ,   Oral Health ,   School Level ,   Student Level

---

ICR Summary 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	21	400	0	-379	0	0
Annual Time Burden (Hours)	147	2,800	0	-2,653	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden in reduction is due to decrease in respondents from 400 to 21.

---

Annual Cost to Federal Government: $64,545

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? Uncollected

---

Common Form ICR:  No

---

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: 06/14/2018

---