Information Collection

LAN Documents (CMS-10659 and CMS-10660)

IC 228452 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⚠️ Notice: This information collection may be referencing outdated material.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-10659 LAN Documents (CMS-10659 and CMS-10660)	Form and Instruction
CMS-10659 Overall Evaluations Summit 2017 CMS-10659 GenIC 17 New_Overall_Evaluations_Summit_2017.docx	Form and Instruction
CMS-10659 Summit web portal evalations CMS-10659 GenIC17 LAN Summit web portal evaluations.pdf	Form and Instruction
CMS-10660 Sessions Evaluations CMS-10660 GenIC18 New_Session_Evaluations_Summit_2017.docx	Form and Instruction
CMS-10659 Supporting Statement GenIC17 LAN Summit Evaluation Form.docx CMS-10659 Supporting Statement	IC Document
CMS-10660 Supporting Statement GenIC18 LAN Session Evaluation Form.docx CMS-10660 Supporting Statement	IC Document
0938-1297 Burden Table for GenICs 17 and 18.docx Burden Table	IC Document

IC Title:

LAN Documents (CMS-10659 and CMS-10660)

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-10659	Overall Evaluations Summit 2017	CMS-10659 GenIC 17 New_Overall_Evaluations_Summit_2017.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10659	Summit web portal evalations	CMS-10659 GenIC17 LAN Summit web portal evaluations.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10660	Sessions Evaluations	CMS-10660 GenIC18 New_Session_Evaluations_Summit_2017.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,760

Number of Respondents for Small Entity: 352

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

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	1,760	1,760
Annual IC Time Burden (Hours)	147	147
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10659 Supporting Statement	CMS-10659 Supporting Statement GenIC17 LAN Summit Evaluation Form.docx	09/25/2017
CMS-10660 Supporting Statement	CMS-10660 Supporting Statement GenIC18 LAN Session Evaluation Form.docx	09/25/2017
Burden Table	0938-1297 Burden Table for GenICs 17 and 18.docx	09/25/2017

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