Information Collection Request

(CMS-10621) Merit-based Incentive Payment System

ICR 201606-0938-001 · OMB 0938-1314 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10621 Proposed CPIA Inventory Form and Instruction New Available
Form CMS-10621 List of Advancing Care Information Performance Category Form and Instruction New Available
Form CMS-10621 MIPS Data Validation Electronic Survey Form and Instruction New Available
Form CMS-10621 MIPS Data Validation Survey Respondent Communication Form and Instruction New Available
Form CMS-10621 QCDR Self-nomination form Form and Instruction New Available
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction New Available
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction New Available
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction New Available
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction New Available
MIPS PRA Supporting Statement Part B 5.26.2016 clean.docx Supporting Statement B Uploaded 2016-06-02 Available
CMS-10621 MIPS Supporting Statement A 6.1.2016 clean (1).docx Supporting Statement A Uploaded 2016-06-02 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
221786 $414.1430 (Partial Qualifying APM Participant (QP) election) New
221785 §414.1360 (CPIA) Form and Instruction NewProposed CPIA Inventory
221784 §414.1375 (Advancing Care Information Performance Category) Form and Instruction NewList of Advancing Care Information Performance Category
221783 §414.1390 (Data Validation and Auditing) Form and Instruction NewMIPS Data Validation Electronic Survey
221783 §414.1390 (Data Validation and Auditing) Form and Instruction NewMIPS Data Validation Survey Respondent Communication
221782 §414.1400 QCDR and qualified registry self nomination Form and Instruction NewQCDR Self-nomination form
221781 §414.1330 and §414.1335 CMS Web Interface Submission Mechanism Form and Instruction NewList of Quality Performance Category Measures
221780 §414.1330 and §414.1335 EHR Submission Mechanism Form and Instruction NewList of Quality Performance Category Measures
221779 §414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Form and Instruction NewList of Quality Performance Category Measures
221777 §414.1330 and §414.1335 Claims Submission Mechanism Form and Instruction NewList of Quality Performance Category Measures

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
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0 0 0
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table that charts list of burden
IC Title Form No. Form Name
$414.1430 (Partial Qualifying APM Participant (QP) election)
§414.1330 and §414.1335 CMS Web Interface Submission Mechanism CMS-10621
§414.1330 and §414.1335 Claims Submission Mechanism CMS-10621
§414.1330 and §414.1335 EHR Submission Mechanism CMS-10621
§414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism CMS-10621
§414.1360 (CPIA) CMS-10621
§414.1375 (Advancing Care Information Performance Category) CMS-10621
§414.1390 (Data Validation and Auditing) CMS-10621, CMS-10621 ,  
§414.1400 QCDR and qualified registry self nomination CMS-10621



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  No