Information Collection

LAN Summit - Total Event Evaluations (CMS-10713)

IC 256577 under ICR 202202-0938-003 · OMB 0938-1297.

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 Summit Evaluation Proposed Questions Draft 2022 Summit Evaluation Proposed Questions.docx	Form and Instruction
GenIC Supporting Statement CMS-10713.docx Gen-IC Supporting Statement	IC Document

IC Title:

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-10713	Summit Evaluation Proposed Questions	Draft 2022 Summit Evaluation Proposed Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,133

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	1,133	1,133
Annual IC Time Burden (Hours)	567	567
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Gen-IC Supporting Statement	GenIC Supporting Statement CMS-10713.docx	10/24/2022

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