OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

LAN Documents (CMS-10659 and CMS-10660)

IC 228452 under ICR 201509-0938-006 · OMB 0938-1297.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

LAN Documents (CMS-10659 and CMS-10660)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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

Health Health Care Services

 

1,760 352
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,760 0 1,760 0 0 0
Annual IC Time Burden (Hours) 147 0 147 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.