Information Collection

LAN Documents (CMS-10602, CMS-10603 and CMS-10604)

IC 220071 under ICR 201509-0938-006 · OMB 0938-1297.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1297 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10603 LAN Summit Abstract Submission LAN Documents (CMS-10602, CMS-10603 and CMS-10604)	Form and Instruction
Form CMS-10604 LAN Registration Form LAN Documents (CMS-10602, CMS-10603 and CMS-10604)	Form and Instruction
Form CMS-10602 LAN Summit Registration Form LAN Documents (CMS-10602, CMS-10603 and CMS-10604)	Form and Instruction
CMS-10603 LAN Summit Abstract Submission CMS-10603 GenIC2 Instrument - LAN Summit Abstract Submission.pdf	Form and Instruction
CMS-10604 LAN Registration Form CMS-10604 GenIC3 Instrument - LAN Registration Form.pdf	Form and Instruction
CMS-10602 LAN Summit Registration Form CMS-10602 LAN Summit Registration Updated.pdf	Form and Instruction
CMS - 10602 GenIC1 LAN Summit Registration Form.docx CMS-10602 Supporting Statement	IC Document
CMS- 10603 GenIC2 LAN Summit Abstract Submission Form.docx CMS-10603 Supporting Statement	IC Document
0938-1297 Burden Table for GenICs 1 2 and 3.docx Burden Table for GenIC #1, 2 and 3	IC Document
CMS- 10604 GenIC3 LAN Registration 2016.docx CMS-10604 Supporting Statement	IC Document

IC Title:

LAN Documents (CMS-10602, CMS-10603 and CMS-10604)

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10603	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10604	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10602	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,850

Number of Respondents for Small Entity: 128

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	4,850	4,850
Annual IC Time Burden (Hours)	648	648
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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