Information Collection

LAN Documents (CMS-10670, CMS-10671, and CMS-10672)

IC 231525 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⚠️ Notice: This information collection may be referencing outdated material.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-10670 LAN Documents (CMS-10670, CMS-10671, and CMS-10672)	Form and Instruction
CMS-10670 LAN Summit Registration Form CMS-10670 GenIC 20 2018 LAN Summit Registration Form.jpg	Form and Instruction
CMS-10671 LAN Summit Evaluation Form CMS-10671 GenIC21 2018 LAN Summit Evaluation Form.docx	Form and Instruction
CMS-10672 LAN Session Evaluation Form CMS-10672 GenIC 22 2018 LAN Session Evaluation Form.docx	Form and Instruction
0938-1297 Burden Table for GenICs 20..21..22.docx LAN Burden Table	IC Document
CMS-10670 GenIC20 2018 LAN Summit Registration Form Supporting Statement.docx CMS-10670 Supporting Statement	IC Document
CMS-10671 GenIC21 2018 LAN Summit Evaluation Form Supporting Statememt.docx CMS-10671 Supporting Statement	IC Document
CMS-10672 GenIC18 2018 LAN Session Evaluation Form Supporting Statement.docx CMS-10672 Supporting Statement	IC Document

IC Title:

LAN Documents (CMS-10670, CMS-10671, and CMS-10672)

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-10670	LAN Summit Registration Form	CMS-10670 GenIC 20 2018 LAN Summit Registration Form.jpg	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10671	LAN Summit Evaluation Form	CMS-10671 GenIC21 2018 LAN Summit Evaluation Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10672	LAN Session Evaluation Form	CMS-10672 GenIC 22 2018 LAN Session Evaluation Form.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,360

Number of Respondents for Small Entity: 672

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	3,360	3,360
Annual IC Time Burden (Hours)	414	414
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
LAN Burden Table	0938-1297 Burden Table for GenICs 20..21..22.docx	05/21/2018
CMS-10670 Supporting Statement	CMS-10670 GenIC20 2018 LAN Summit Registration Form Supporting Statement.docx	05/21/2018
CMS-10671 Supporting Statement	CMS-10671 GenIC21 2018 LAN Summit Evaluation Form Supporting Statememt.docx	05/21/2018
CMS-10672 Supporting Statement	CMS-10672 GenIC18 2018 LAN Session Evaluation Form Supporting Statement.docx	05/21/2018

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