Information Collection Request

Generic Clearance for the Heath Care Payment Learning and Action Network (CMS-10575)

ICR 201509-0938-006 · OMB 0938-1297 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10670 LAN Documents (CMS-10670, CMS-10671, and CMS-10672) Form and Instruction New Repair queued
Form CMS-10620 Tracking the Adoption of Alternative Payment Models (CMS-10620) Form and Instruction New Available
Form CMS-10659 LAN Documents (CMS-10659 and CMS-10660) Form and Instruction New Available
Form CMS-10655 LAN Document (CMS-10655) Form and Instruction New Available
Form CMS-10620 Tracking the Adoption of Alternative Payment Models (CMS-10620) Form and Instruction New Available
Form CMS-10648 (CMS-10648) LAN Forum –Event Evaluations Form and Instruction New Available
Form CMS-10644 (CMS-10644) LAN Forum Registration Form Form and Instruction New Available
Form CMS-10640 CMS-10640 (MAC) Participant Form Form and Instruction New Available
Form CMS-10620 (CMS-10620) Tracking the adoption of alternative payment models Form and Instruction New Available
Form CMS-10617 LAN Documents (CMS-10616, CMS-10617 and CMS-10618) Form and Instruction New Repair queued
Form CMS-10612 LAN Documents (CMS-10612, CMS-10613 and CMS-10614) Form and Instruction New Available
Form CMS-10606 LAN Documents (CMS-10606, CMS-10607 and CMS-10608) Form and Instruction New Available
Form CMS-10602 LAN Documents (CMS-10602, CMS-10603 and CMS-10604) Form and Instruction New Available
CMS-10575 Final SS - Part B - 1 21 16 clean.docx Supporting Statement B Uploaded 2016-01-28 Available
CMS-10575 Final SS - Part A - 1 21 16 clean.docx Supporting Statement A Uploaded 2016-01-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
231525 LAN Documents (CMS-10670, CMS-10671, and CMS-10672) Form and Instruction New
230265 Tracking the Adoption of Alternative Payment Models (CMS-10620) Form and Instruction New
228452 LAN Documents (CMS-10659 and CMS-10660) Form and Instruction New
227625 LAN Document (CMS-10655) Form and Instruction New
227104 Tracking the Adoption of Alternative Payment Models (CMS-10620) Form and Instruction New
226339 (CMS-10648) LAN Forum –Event Evaluations Form and Instruction New
226053 (CMS-10644) LAN Forum Registration Form Form and Instruction New
224394 CMS-10640 (MAC) Participant Form Form and Instruction New
221558 (CMS-10620) Tracking the adoption of alternative payment models Form and Instruction New
221098 LAN Documents (CMS-10616, CMS-10617 and CMS-10618) Form and Instruction New
220737 LAN Documents (CMS-10612, CMS-10613 and CMS-10614) Form and Instruction New
220496 LAN Documents (CMS-10606, CMS-10607 and CMS-10608) Form and Instruction New
220071 LAN Documents (CMS-10602, CMS-10603 and CMS-10604) Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2019 36 Months From Approved
48,440 0 0
49,400 0 0
0 0 0





Reginfo record details
13
table that charts list of burden
IC Title Form No. Form Name
LAN Documents (CMS-10606, CMS-10607 and CMS-10608) CMS-10608, CMS-10606, CMS-10607 Speaker Request Form ,   Webinar Registration - LAN update ,   Webinar Registration - LAN Learning
CMS-10640 (MAC) Participant Form CMS-10640 MAC Participant Form
LAN Documents (CMS-10670, CMS-10671, and CMS-10672) CMS-10671, CMS-10672, CMS-10670 LAN Summit Registration Form ,   LAN Summit Evaluation Form ,   LAN Session Evaluation Form
LAN Documents (CMS-10602, CMS-10603 and CMS-10604) CMS-10603, CMS-10604, CMS-10602 LAN Summit Registration Form ,   LAN Summit Abstract Submission ,   LAN Registration Form
LAN Documents (CMS-10659 and CMS-10660) CMS-10659, CMS-10659, CMS-10660 Overall Evaluations Summit 2017 ,   Summit web portal evalations ,   Sessions Evaluations
(CMS-10644) LAN Forum Registration Form CMS-10644 LAN Forum Registration Form
LAN Documents (CMS-10612, CMS-10613 and CMS-10614) CMS-10613, CMS-10614, CMS-10612 Webinar Registration - LAN Listening ,   LAN Summit Session Evaluation Form ,   LAN Summit Evaluation Form
(CMS-10648) LAN Forum –Event Evaluations CMS-10648 LAN Forum Evaluation Form
Tracking the Adoption of Alternative Payment Models (CMS-10620) CMS-10620, CMS-10620 National Data Collection Metric ,   National Data Collection Metrics - Excel
LAN Document (CMS-10655) CMS-10655 GenIC#16 LAN Summit 2017 Registration Form
Tracking the Adoption of Alternative Payment Models (CMS-10620) CMS-10620, CMS-10620, CMS-10620 National Data Collection Metrics ,   APM Survey ,   Informational Questions
LAN Documents (CMS-10616, CMS-10617 and CMS-10618) CMS-10617, CMS-10616, CMS-10618 Webinar Post-Session Evaluation Form - Listening ,   Webinar Post-Session Evaluation - Learnings ,   Webinar Post-Session Evaluation Form - Lan Update
(CMS-10620) Tracking the adoption of alternative payment models CMS-10620 National Data Collection Metrics

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 48,440 0 0 48,440 0 0
Annual Time Burden (Hours) 49,400 0 0 49,400 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No