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

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⚠️ Notice: This information collection may be referencing outdated material.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-10584 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

Information Collection (IC) Details

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:

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 %

	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

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.