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 ?414.1360 (Improvement Activities) Form and Instruction Modified Available
Form CMS-10621 ?414.1375 (Advancing Care Information Performance Category) Form and Instruction Modified Available
Form CMS-10621 ?414.1400 QCDR and qualified registry self nomination Form and Instruction Modified Repair queued
Form CMS-10621 ?414.1330 and §414.1335 CMS Web Interface Submission Mechanism Form and Instruction Modified Available
Form CMS-10621 ?414.1330 and §414.1335 EHR Submission Mechanism Form and Instruction Modified Available
Form CMS-10621 ?414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Form and Instruction Modified Available
Form CMS-10621 ?414.1330 and §414.1335 Claims Submission Mechanism 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

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





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