OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Care Payment Learning and Action Network (CMS-10559)

IC 215761 under ICR 201506-0938-013 · OMB 0938-1185.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Health Care Payment Learning and Action Network (CMS-10559)
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10559 Health Care Payment Learning and Action Network CMS-10559.Instrument.docx Yes Yes Fillable Fileable Signable

Health Health Care Services

 

1,000 250
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10559. Generic_Clearance_Submission_Template CMS-10559. Generic_Clearance_Submission_Template.doc 03/19/2015
Generic Clearance Submission Template REVISED CMS-10559 Generic_Clearance_Submission_Template (REVISED).doc 03/19/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.