| 
			1:
			 Service Utilization by Type of Organization Requesting Service
			and Outcomes for Reporting Period  
			 Category 
				Total
				number of individual clients/departments requesting TRC services
				and hours of client contact service provided, including
				preparation time.Total
				number of new/first timeTotal
				number of repeat clients (those who received service in the past
				– prior to the  current reporting period – who are
				returning for more/other services)Total
				number of hours of technical assistance provided including
				preparation time | 
			1:
			 Service Utilization by State and Type of Organization Requesting
			Service 
			 
 Service
			Utilization 
			 
 Type
			of Organization Requesting Service 
				Academic
				Institution/School 
				Associations/Organizations
				(National, State or Regional) 
				ClinicFunders
				(Foundations/Health Plans)Hospital/Health
				System 
				 
					Critical
					Access Hospital (CAH) (25 beds or less)Small
					Rural Hospital (50 beds or less) 
					Health
					Resources and Services Administration (HRSA) Grant Funded EntityGovernment
					Agency (Federal, State, Regional or Local) Tribal/IHS 
				
					
					Legislator/Policy
					Maker /staffer(or office)Telehealth
					Resource Center 
					VendorOther
					(list other and provide total numbers) 
					 
 | 
	
		| 
			2:
			 Method of Query for Reporting Period Category 
				EmailPhoneReferral
				from Another TRCSocial
				Media (Twitter, Facebook, LinkedIn, etc.)TRC
				InitiatedWebsiteOther 
 | 
			2:
			 TRC Technical Assistance Communication Method of Inquiry and
			Response 
			 
 Method
			of Technical Assistance Inquiry 
			 
				Phone
				
				In-Person
				Contact at an event (ie. training, conference, meeting, other)TRC
				Website Form 
				Referral
				from Another TRC 
				Social
				Media (Twitter, Facebook, LinkedIn, etc.)TRC
				InitiatedOther
				
				 
 Method
			Used to Respond to Inquiries 
			 
				Email
				
				Phone
				
				Videoconference
				
				In
				Person VisitOther 
 | 
	
		| 
			3:
			 Topic of Query for Reporting Period Category 
				General
				InformationClinical
				Service Program Development/OperationsEquipment
				and Technology Assessment/SelectionFinancial
				(Reimbursement, Business Models, Grants)PolicyOther 
 | 
			3:
			 Topic of Inquiry 
			 Category 
				Financial
				(Reimbursement, Business Models, Grants) 
				Policy/Legal
				 
				Market
				Analysis 
				About
				my TRC 
				Broadband
				network infrastructure  
				Readiness
				Assessment 
				Distance
				LearningProgram
				Evaluation 
				Strategic
				Planning 
				Tools
				and TemplatesGeneral
				Telehealth InformationClinical
				Service Program Development/Operations 
				Equipment
				and Technology Assessment/Selection 
				Other 
 | 
	
		| 
			4:
			 Types of Services Provided by TRC during the Reporting Period Category Training/Education
			and Outreach Events 
				Organize/Host
				Conference or Training Event (# of Events, Total Direct Service
				Hours, Total # of Participants)  
				Presentation
				at Conferences/Meetings/Webinars (# of Presentations, Total
				Direct Service Hours, Total # of Participants)Other Communications/Promotional
			Activities 
				Exhibits
				(# of hours, # of contacts)Newsletter
				(# of  newsletters, # of subscribers)Web
				Site (# unique visitors, # of pages viewed by visitors)Research
				Publications (# of publications)General
				Media (# interviews/articles) Social
			Media 
				Facebook
				(# of page likes, # of posts)Twitter
				(# of followers, # of tweets)LinkedIn
				(# of followers, # of posts) Other Technical
			Assistance/Consultation Method
			Used to Respond to Queries 
				Email
				(# responses)Phone
				(# responses)Videoconference
				(# responses)In
				Person Visit  (# responses)Group
				Collaboration/Planning (# responses) Client
			Satisfaction Survey Results The
			following 4 questions come from the standardized Client
			Satisfaction Questionnaire – CSQ-8 and ratings are on a 4
			point scale) 
				How
				would you rate the quality of service you received –
				Excellent, Good, Fair, Poor  (# respondents, average rating)If
				a colleague were in need of similar help, would you recommend our
				program to him or her – No, definitely not, No, I don’t
				think so, Yes, I think so, Yes definitely  (# respondents,
				average rating)In
				an overall, general sense, how satisfied are you with the
				services you have received – Very satisfied, Mostly
				satisfied, Indifferent or mildly dissatisfied, Quite dissatisfied
				  (# respondents, average rating)If
				you were to seek help again, would you come back to our program –
				 No, definitely not, No, I don’t think so, Yes, I think so,
				Yes, definitely         (# respondents, average rating)Tools/Materials/Resources
				(# developed, # distributed) 
 | 
			4:
			 Types of Services Provided by TRC  
			 
 Training/Education
			and Outreach 
			 
 Communications/Promotional
			Activities 
			 
 Tools/Materials/Resources
			
			 
 |