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Data Collection for Medicare Facilities Performing Carotid Artery Stenting with Embolic Protection in Patients at High Risk for Carotid Endarterectomy
Data Collection for Medicare Facilities Performing Carotid Artery Stenting with Embolic Protection in Patients at High Risk for Carotid Endarterectomy
OMB: 0938-1011
IC ID: 45536
OMB.report
HHS/CMS
OMB 0938-1011
ICR 201309-0938-033
IC 45536
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1011 can be found here:
2020-08-14 - Extension without change of a currently approved collection
2017-04-28 - Revision of a currently approved collection
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
URL
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
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:
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 %
Approved
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
0
0
-250
0
250
0
Annual IC Time Burden (Hours)
0
0
-125
0
125
0
Annual IC Cost Burden (Dollars)
0
0
0
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.