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

Generic Clearance for the Heath Care Payment Learning and Action Network (CMS-10575)

⚠️ Notice: This information collection may be referencing outdated material.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-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

Information Collection (IC) Details

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:

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 %

	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

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.