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 ?414.1360 (CPIA) Form and Instruction New Available
Form CMS-10621 ?414.1375 (Advancing Care Information Performance Category) Form and Instruction New Available
Form CMS-10621 ?414.1390 (Data Validation and Auditing) Form and Instruction New Available
Form CMS-10621 ?414.1400 QCDR and qualified registry self nomination Form and Instruction New Available
Form CMS-10621 ?414.1330 and §414.1335 CMS Web Interface Submission Mechanism Form and Instruction New Available
Form CMS-10621 ?414.1330 and §414.1335 EHR Submission Mechanism Form and Instruction New Available
Form CMS-10621 ?414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Form and Instruction New Available
Form CMS-10621 ?414.1330 and §414.1335 Claims Submission Mechanism 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 New
221784 ?414.1375 (Advancing Care Information Performance Category) Form and Instruction New
221783 ?414.1390 (Data Validation and Auditing) Form and Instruction New
221782 ?414.1400 QCDR and qualified registry self nomination Form and Instruction New
221781 ?414.1330 and §414.1335 CMS Web Interface Submission Mechanism Form and Instruction New
221780 ?414.1330 and §414.1335 EHR Submission Mechanism Form and Instruction New
221779 ?414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Form and Instruction New
221777 ?414.1330 and §414.1335 Claims Submission Mechanism Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0







Reginfo record details
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