Kccq-10

Transcatheter Valve Therapy Registry and KCCQ-10

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1202 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10443 KCCQ-10 Form and Instruction
CMS-10443 KCCQ-10 short kccq 2012-01-31.DOCX Form and Instruction

Information Collection (IC) Details

IC Title:	KCCQ-10	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

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-10443	KCCQ-10	short kccq 2012-01-31.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	18,000	18,000
Annual IC Time Burden (Hours)	2,100	2,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.