TVT Registry form for TMVR

(CMS–10531) Transcatheter Mitral Valve Repair (TMVR) National Coverage Decision (NCD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1274 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10531 TVT Registry form for TMVR Form and Instruction
CMS-10531 TVT Registry 2-1_tvt_mitralleafletclipdcf with disclosure statement on page 1.pdf Form and Instruction
TVT Registry Form Changes.pdf Crosswalk for TVT form IC Document

Information Collection (IC) Details

IC Title:	TVT Registry form for TMVR	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
Form and Instruction	CMS-10531	TVT Registry	2-1_tvt_mitralleafletclipdcf with disclosure statement on page 1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,897	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	3,897	-103	4,000
Annual IC Time Burden (Hours)	4,092	-108	4,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk for TVT form	TVT Registry Form Changes.pdf	07/16/2018

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