TVT Registry form for TMVR

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

Documents and Forms

Document Name Document Type
Form CMS-10531 TVT Registry form for TMVR Form and Instruction
CMS-10531 TVT Registry tvt_v3_mitralleafetclip_dcf_1_26_2021-(1) (with PRA disclosure) 2021.pdf Form and Instruction

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	tvt_v3_mitralleafetclip_dcf_1_26_2021-(1) (with PRA disclosure) 2021.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,649	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,649	4,752	3,897
Annual IC Time Burden (Hours)	12,974	8,882	4,092
Annual IC Cost Burden (Dollars)	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.