Information Collection

(CMS-10644) LAN Forum Registration Form

IC 226053 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⚠️ Notice: This information collection may be referencing outdated material.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-10644 (CMS-10644) LAN Forum Registration Form	Form and Instruction
CMS-10644 LAN Forum Registration Form CMS-10644 GenIC14 LAN Forum Registration Screenshot.png	Form and Instruction
CMS-10644 GenIC14 LAN Forum Registration Form.docx CMS-10644 Supporting Statement	IC Document

IC Title:

(CMS-10644) LAN Forum Registration Form

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10644	LAN Forum Registration Form	CMS-10644 GenIC14 LAN Forum Registration Screenshot.png		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 1,000

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	2,500	2,500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10644 Supporting Statement	CMS-10644 GenIC14 LAN Forum Registration Form.docx	03/14/2017

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