Information Collection

LAN Summit – Total Event Evaluations (CMS-10713)

IC 237472 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⚠️ Notice: This information collection may be referencing outdated material.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-10713 LAN Summit – Total Event Evaluations (CMS-10713)	Form and Instruction
CMS-10713 Guidebook - Breakout Session Evaluation Questions Guidebook - Breakout Session Evaluation Questions.pdf	Form and Instruction
CMS-10713 Mentimeter - Overall Summit Evaluation Questions Mentimeter - Overall Summit Evaluation Questions.pdf	Form and Instruction
CMS-10713 Overall Eval Overall Eval_V1.docx	Form and Instruction
CMS-10713 Session Evaluation Session Eval.docx	Form and Instruction
GenIC19 LAN Summit Evaluation Form Clean.docx Supporting Statement CMS-10713	IC Document

IC Title:

LAN Summit â Total Event Evaluations (CMS-10713)

Agency IC Tracking Number:

CMMI

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-10713	Guidebook - Breakout Session Evaluation Questions	Guidebook - Breakout Session Evaluation Questions.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10713	Mentimeter - Overall Summit Evaluation Questions	Mentimeter - Overall Summit Evaluation Questions.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10713	Overall Eval	Overall Eval_V1.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10713	Session Evaluation	Session Eval.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

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	400	400
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement CMS-10713	GenIC19 LAN Summit Evaluation Form Clean.docx	08/20/2019

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