Information Collection

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

IC 45536 under ICR 201309-0938-033 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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 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
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 CMS-10199 CAS Data Element List REVISED-1-5-07.doc 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: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10199	CMS-10199.CAS Data Element	CMS-10199 CAS Data Element List REVISED-1-5-07.doc	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	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: 250	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 %

	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-250	250
Annual IC Time Burden (Hours)	-125	125
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.