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Federal forms, ICRs, and supporting documents

Information Collection

Data Collection for Medicare Beneficiaries Receiving Implantable Cardioverter-defibrillators for Primary Prevention of Sudden Cardiac Death

IC 8827 under ICR 201705-0938-001 · OMB 0938-0967.

Documents and Forms
Document Name
Document Type
Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Data Collection for Medicare Beneficiaries Receiving Implantable Cardioverter-defibrillators for Primary Prevention of Sudden Cardiac Death
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction ICDv2CodersDataDictionary22.pdf Yes No Fillable Fileable
Form and Instruction CMS-10151 ICD Registry Form v 2.2 ICD_v2_DataCollectionForm_GenLeads_2 2_508 with updated PRA disclosure and expiration.pdf Yes Yes Fillable Fileable

Health Health Care Services

Data Collection Secondary to Coverage Decision System   70 FR 53667

1,600 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 80,000 0 0 80,000 0 0
Annual IC Time Burden (Hours) 20,000 0 0 20,000 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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