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LAN Documents (CMS-10659 and CMS-10660)
Generic Clearance for the Heath Care Payment Learning and Action Network (CMS-10575)
OMB: 0938-1297
IC ID: 228452
OMB.report
HHS/CMS
OMB 0938-1297
ICR 201509-0938-006
IC 228452
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1297 can be found here:
2022-02-25 - Extension without change of a currently approved collection
2019-02-05 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10659
LAN Documents (CMS-10659 and CMS-10660)
Form and Instruction
CMS-10659 Overall Evaluations Summit 2017
CMS-10659 GenIC 17 New_Overall_Evaluations_Summit_2017.docx
Form and Instruction
CMS-10659 Summit web portal evalations
CMS-10659 GenIC17 LAN Summit web portal evaluations.pdf
Form and Instruction
CMS-10660 Sessions Evaluations
CMS-10660 GenIC18 New_Session_Evaluations_Summit_2017.docx
Form and Instruction
CMS-10659 Supporting Statement GenIC17 LAN Summit Evaluation Form.docx
CMS-10659 Supporting Statement
IC Document
CMS-10660 Supporting Statement GenIC18 LAN Session Evaluation Form.docx
CMS-10660 Supporting Statement
IC Document
0938-1297 Burden Table for GenICs 17 and 18.docx
Burden Table
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
LAN Documents (CMS-10659 and CMS-10660)
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-10659
Overall Evaluations Summit 2017
CMS-10659 GenIC 17 New_Overall_Evaluations_Summit_2017.docx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10659
Summit web portal evalations
CMS-10659 GenIC17 LAN Summit web portal evaluations.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10660
Sessions Evaluations
CMS-10660 GenIC18 New_Session_Evaluations_Summit_2017.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,760
Number of Respondents for Small Entity:
352
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,760
0
1,760
0
0
0
Annual IC Time Burden (Hours)
147
0
147
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
CMS-10659 Supporting Statement
CMS-10659 Supporting Statement GenIC17 LAN Summit Evaluation Form.docx
09/25/2017
CMS-10660 Supporting Statement
CMS-10660 Supporting Statement GenIC18 LAN Session Evaluation Form.docx
09/25/2017
Burden Table
0938-1297 Burden Table for GenICs 17 and 18.docx
09/25/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.