Information Collection

LAN Documents (CMS-10606, CMS-10607 and CMS-10608)

IC 220496 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⚠️ Notice: This information collection may be referencing outdated material.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-10606 LAN Documents (CMS-10606, CMS-10607 and CMS-10608)	Form and Instruction
CMS-10606 Speaker Request Form CMS- 10606 GenIC4 Instrument - Speaker Request Form.pdf	Form and Instruction
CMS-10608 Webinar Registration - LAN update CMS-10608 GenIC6 Instrument - Webinar Registration Form.pptx	Form and Instruction
CMS-10607 Webinar Registration - LAN Learning CMS- 10607 GenIC5 Instrument - Webinar Registration Form.pptx	Form and Instruction
0938-1297 Burden Table for GenICs 4 5 and 6.docx 0938-1297 Burden Table for GenICs 4 5 and 6	IC Document
CMS-10606 GenIC4 Speaker Request Form v2.docx CMS-10606 Supporting Statement	IC Document
CMS-10607 GenIC5 Webinar Registration - LAN Learnings v2.docx CMS-10607 Supporting Statement	IC Document
CMS-10608 GenIC6 Webinar Registration - LAN Updates v2.docx CMS-10608 Supporting Statement	IC Document

IC Title:

LAN Documents (CMS-10606, CMS-10607 and CMS-10608)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10606	Speaker Request Form	CMS- 10606 GenIC4 Instrument - Speaker Request Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10608	Webinar Registration - LAN update	CMS-10608 GenIC6 Instrument - Webinar Registration Form.pptx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10607	Webinar Registration - LAN Learning	CMS- 10607 GenIC5 Instrument - Webinar Registration Form.pptx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,224

Number of Respondents for Small Entity: 2,645

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	13,224	13,224
Annual IC Time Burden (Hours)	666	666
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0938-1297 Burden Table for GenICs 4 5 and 6	0938-1297 Burden Table for GenICs 4 5 and 6.docx	03/07/2016
CMS-10606 Supporting Statement	CMS-10606 GenIC4 Speaker Request Form v2.docx	03/14/2016
CMS-10607 Supporting Statement	CMS-10607 GenIC5 Webinar Registration - LAN Learnings v2.docx	03/14/2016
CMS-10608 Supporting Statement	CMS-10608 GenIC6 Webinar Registration - LAN Updates v2.docx	03/14/2016

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