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

(CMS-10199) Data Collection for Medicare Beneficiaries Receiving Carotid Artery Stenting with Embolic Protection

⚠️ Notice: This information collection may be referencing outdated material.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
CAS data elements 2017 3-15-17.pdf Instruction
FINAL_CAS Data Entry and Submission Instructions_6_15_2015 3-15-17.pdf Instruction
CMS-10199 CMS-10199.stent data entry CAS Data Entry Form 2017 (2).pdf Form
CMS-10199 crosswalk 2017.pdf Crosswalk IC Document

Information Collection (IC) Details

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CAS data elements 2017 3-15-17.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10199	CMS-10199.stent data entry	CAS Data Entry Form 2017 (2).pdf	Yes	Yes	Fillable Fileable
Instruction			FINAL_CAS Data Entry and Submission Instructions_6_15_2015 3-15-17.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,370	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,740	1,740	1,000
Annual IC Time Burden (Hours)	28,770	28,270	500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	CMS-10199 crosswalk 2017.pdf	04/26/2017

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