LAN Summit Registration Form (CMS-10702)

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

IC Title:	LAN Summit Registration Form (CMS-10702)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.