Information Collection

Health Care Payment Learning and Action Network Registration (CMS-10584)

IC 218155 under ICR 201506-0938-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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-10584 LAN Summit Registration Form Health Care Payment Learning and Action Network Registration (CMS-10584)	Form and Instruction
CMS-10584 LAN Summit Registration Form LAN Summit Registration_v7.docx	Form and Instruction
CMS-10584.LAN Registration PRA submission.doc CMS-10584.LAN Registration PRA submission	IC Document

IC Title:

Health Care Payment Learning and Action Network Registration (CMS-10584)

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-10584	LAN Summit Registration Form	LAN Summit Registration_v7.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 1,000

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	5,000	5,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10584.LAN Registration PRA submission	CMS-10584.LAN Registration PRA submission.doc	09/11/2015

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