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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CMS-10602 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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10602	LAN Summit Registration Form	CMS-10602 LAN Summit Registration Updated.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10603	LAN Summit Abstract Submission	CMS-10603 GenIC2 Instrument - LAN Summit Abstract Submission.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10604	LAN Registration Form	CMS-10604 GenIC3 Instrument - LAN Registration Form.pdf	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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	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

Title	Document	Date Uploaded
CMS-10602 Supporting Statement	CMS - 10602 GenIC1 LAN Summit Registration Form.docx	02/11/2016
CMS-10603 Supporting Statement	CMS- 10603 GenIC2 LAN Summit Abstract Submission Form.docx	02/11/2016
Burden Table for GenIC #1, 2 and 3	0938-1297 Burden Table for GenICs 1 2 and 3.docx	02/11/2016
CMS-10604 Supporting Statement	CMS- 10604 GenIC3 LAN Registration 2016.docx	02/11/2016

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