Information Collection

LAN Documents (CMS-10616, CMS-10617 and CMS-10618)

IC 221098 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⚠️ Notice: This information collection may be referencing outdated material.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-10617 LAN Documents (CMS-10616, CMS-10617 and CMS-10618) Form and Instruction
CMS-10616 Webinar Post-Session Evaluation Form - Lan Update CMS-10616 GenIC10 Instrument - Webinar Post-Session Eval Form.pdf Form and Instruction
CMS-10617 Webinar Post-Session Evaluation Form - Listening CMS-10617 GenIC11 Instrument - Webinar Post-Session Eval Form.pdf Form and Instruction
CMS-10618 Webinar Post-Session Evaluation - Learnings CMS-10618 GenIC12 Instrument - Webinar Post-Session Eval Form.pdf Form and Instruction
0938-1297 Burden Table for GenICs 10 11 and 12.docx Burden Table for GenIC#10 11 and 12 IC Document
CMS-10616 Supporting Statement GenIC10 Webinar Post Session Evaluation - LAN Updates.docx CMS-10616 Supporting Statement IC Document
CMS-10617 Supporting Statement GenIC11 Webinar Post Session Evaluation - LAN Listening.docx CMS-10617 Supporting Statement IC Document
CMS-10618 Supporting Statement GenIC12 Webinar Post Session Evaluation - LAN Learning.docx Supporting Statement 10618 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LAN Documents (CMS-10616, CMS-10617 and CMS-10618)	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-10617	Webinar Post-Session Evaluation Form - Listening	CMS-10617 GenIC11 Instrument - Webinar Post-Session Eval Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10618	Webinar Post-Session Evaluation - Learnings	CMS-10618 GenIC12 Instrument - Webinar Post-Session Eval Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10616	Webinar Post-Session Evaluation Form - Lan Update	CMS-10616 GenIC10 Instrument - Webinar Post-Session Eval 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: 1,680	Number of Respondents for Small Entity: 336

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	1,680	1,680
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Table for GenIC#10 11 and 12	0938-1297 Burden Table for GenICs 10 11 and 12.docx	04/14/2016
CMS-10616 Supporting Statement	CMS-10616 Supporting Statement GenIC10 Webinar Post Session Evaluation - LAN Updates.docx	04/14/2016
CMS-10617 Supporting Statement	CMS-10617 Supporting Statement GenIC11 Webinar Post Session Evaluation - LAN Listening.docx	04/14/2016
Supporting Statement 10618	CMS-10618 Supporting Statement GenIC12 Webinar Post Session Evaluation - LAN Learning.docx	04/14/2016

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