Information Collection

Health Care Payment Learning and Action Network (CMS-10559)

IC 215761 under ICR 201412-0938-006 · OMB 0938-1185.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1185 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10559 Health Care Payment Learning and Action Network (CMS-10559)	Form and Instruction
CMS-10559 Health Care Payment Learning and Action Network CMS-10559.Instrument.docx	Form and Instruction
CMS-10559. Generic_Clearance_Submission_Template.doc CMS-10559. Generic_Clearance_Submission_Template	IC Document
CMS-10559 Generic_Clearance_Submission_Template (REVISED).doc Generic Clearance Submission Template REVISED	IC Document

IC Title:

Health Care Payment Learning and Action Network (CMS-10559)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10559	Health Care Payment Learning and Action Network	CMS-10559.Instrument.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 250

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10559. Generic_Clearance_Submission_Template	CMS-10559. Generic_Clearance_Submission_Template.doc	03/19/2015
Generic Clearance Submission Template REVISED	CMS-10559 Generic_Clearance_Submission_Template (REVISED).doc	03/19/2015

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