Information Collection Request

(CMS-10621) Merit-based Incentive Payment System

ICR 201611-0938-002 · OMB 0938-1314 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10621 Improvement Activities Inventory Form and Instruction Modified Available
Form CMS-10621 List of Advancing Care Information Performance Category Form and Instruction Modified Available
Form CMS-10621 QCDR Self-nomination form Form and Instruction Modified Repair queued
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction Modified Available
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction Modified Available
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction Modified Available
Form CMS-10621 List of Quality Performance Category Measures Form and Instruction Modified Available
MIPS Response_to_Public_Comments 10.13.2016.doc Supplementary Document Uploaded 2016-11-01 Available
MIPS PRA Supporting Statement Part B - Passback- clean 3.31.201....doc Supporting Statement B Uploaded 2017-03-31 Available
MIPS PRA Supporting Statement Part A - Passback-clean 3.16.2017.doc Supporting Statement A Uploaded 2017-03-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
224260 414.1400 (Quality Performance Category) CAPHs for MIPS New
221786 $414.1430 (Partial Qualifying APM Participant (QP) election) Modified
221785 §414.1360 (Improvement Activities) Form and Instruction ModifiedImprovement Activities Inventory
221784 §414.1375 (Advancing Care Information Performance Category) Form and Instruction ModifiedList of Advancing Care Information Performance Category
221783 §414.1390 (Data Validation and Auditing) Modified
221782 §414.1400 QCDR and qualified registry self nomination Form and Instruction ModifiedQCDR Self-nomination form
221781 §414.1330 and §414.1335 CMS Web Interface Submission Mechanism Form and Instruction ModifiedList of Quality Performance Category Measures
221780 §414.1330 and §414.1335 EHR Submission Mechanism Form and Instruction ModifiedList of Quality Performance Category Measures
221779 §414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Form and Instruction ModifiedList of Quality Performance Category Measures
221777 §414.1330 and §414.1335 Claims Submission Mechanism Form and Instruction ModifiedList of Quality Performance Category Measures

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2020 36 Months From Approved
1,689,076 0 0
10,947,453 0 0
0 0 0





Reginfo record details
10
table that charts list of burden
IC Title Form No. Form Name
$414.1430 (Partial Qualifying APM Participant (QP) election)
414.1400 (Quality Performance Category) CAPHs for MIPS
§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 (Improvement Activities) 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

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,689,076 0 0 1,689,076 0 0
Annual Time Burden (Hours) 10,947,453 0 0 10,947,453 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No