Information Collection

Data Collection for Medicare Facilities Performing Carotid Artery Stenting with Embolic Protection in Patients at High Risk for Carotid Endarterectomy

IC 45535 under ICR 200610-0938-002 · OMB 0938-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10199 Data Collection for Medicare Facilities Performing Carotid Artery Stenting with Embolic Protection in Patients at High Risk for Carotid Endarterectomy	Instruction
CMS-10199 CAS Data Element List REVISED-1-5-07.doc	Instruction
CMS-10199 CMS-10199.stent data entry CMS-10199.stent data entry.REVISED-1-5-07.xls	Form
CMS-10199 CMS-10199.CAS Data Element List CMS-10199.CAS Data Element List.doc	Instruction
CMS-10199 CMS-10199.stent data entry CMS-10199.stent data entry.xls	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Data Collection for Medicare Facilities Performing Carotid Artery Stenting with Embolic Protection in Patients at High Risk for Carotid Endarterectomy

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Instruction	CMS-10199	CMS-10199.CAS Data Element List	CMS-10199.CAS Data Element List.doc	Yes	Yes	Fillable Fileable
Form	CMS-10199	CMS-10199.stent data entry	CMS-10199.stent data entry.xls	Yes	Yes	Fillable Fileable
Form	CMS-10199	CMS-10199.stent data entry	CMS-10199.stent data entry.REVISED-1-5-07.xls	Yes	Yes	Fillable Fileable
Instruction			CMS-10199 CAS Data Element List REVISED-1-5-07.doc	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: 750

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	750	750
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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