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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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 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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	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 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,000	250	750
Annual IC Time Burden (Hours)	500	125	375
Annual IC Cost Burden (Dollars)	0	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.