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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.