OMB
.report
Search
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
OMB: 0938-1011
IC ID: 45535
OMB.report
HHS/CMS
OMB 0938-1011
ICR 202008-0938-012
IC 45535
( )
Documents and Forms
Document Name
Document Type
CAS data elements 2020.pdf
Instruction
CAS data elements 2020.pdf
Instruction
FINAL_CAS Data Entry and Submission Instructions_6_15_2015 2020.pdf
Instruction
FINAL_CAS Data Entry and Submission Instructions_6_15_2015 2020.pdf
Instruction
CMS-10199 CMS-10199.stent data entry
CAS Data Entry Form 2020.pdf
Form
CMS-10199 CMS-10199.stent data entry
CAS Data Entry Form 2020.pdf
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:
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
Instruction
CAS data elements 2020.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10199
CMS-10199.stent data entry
CAS Data Entry Form 2020.pdf
Yes
Yes
Fillable Fileable
Instruction
FINAL_CAS Data Entry and Submission Instructions_6_15_2015 2020.pdf
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:
1,420
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
2,840
0
0
100
0
2,740
Annual IC Time Burden (Hours)
29,820
0
0
1,050
0
28,770
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.