Information Collection

LAN Summit Registration Form (CMS-10702)

IC 236069 under ICR 201902-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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-10702 LAN Summit Registration Form (CMS-10702)	Form and Instruction
CMS-10702 LAN Summit Registration Form Registration page.pdf www.lansummit.org/registration/	Form and Instruction
GenIC 2019 LAN Summit Registration Form.docx GenIC Supporting Statment CMS-10702	IC Document

IC Title:

LAN Summit Registration Form (CMS-10702)

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-10702	LAN Summit Registration Form	Registration page.pdf	https://www.lansummit.org/registration/	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: 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	1,400	1,400
Annual IC Time Burden (Hours)	233	233
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Supporting Statment CMS-10702	GenIC 2019 LAN Summit Registration Form.docx	05/13/2019

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