OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

ICR 201711-0938-004 · OMB 0938-1314 · Public filing

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10621 Data Template for Candidate Measures Form and Instruction New Available
Form CMS-10621 ACI Call for Measures Submission Form Form and Instruction New Available
Form CMS-10621 Payer Initiated Submission Form Form and Instruction Modified Available
Form CMS-10621 Clinician Initiated Submission Form Form and Instruction Modified Available
CMS-10621 MIPS CY 2018 Supporting Statement Part B 11-17-17.doc Supporting Statement B Uploaded 2017-11-17 Available
CMS-10621 MIPS CY 2018 SS part A Final Rule 20171227 clean final.docx Supporting Statement A Uploaded 2018-01-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229086 414.1330 (Quality Performance Category) Call for Measures Form and Instruction NewData Template for Candidate Measures
229075 414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process New
229074 414.1375 Advancing Care Information Performance Category - Call for Measures Form and Instruction NewACI Call for Measures Submission Form
227511 §414.1395 (Physician Compare) Opt Out for Voluntary Participants Unchanged
227509 §414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process Form and Instruction ModifiedPayer Initiated Submission Form
227509 §414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process Form and Instruction ModifiedClinician Initiated Submission Form
227507 §414.1360 (Improvement Activities Performance Category) Call for Activities Unchanged
227506 §414.1375 (Advancing Care Information Performance Category) Significant Hardships, including for small practices and decertification of EHRs Modified
227505 §414.1330 and §414.1335 Quality Performance Category) Registration and Enrollment for CMS Web Interface Unchanged
227504 §414.1345 Election of Facility-Based Measurement Removed
224260 414.1400 (Quality Performance Category) CAPHs for MIPS Removed
221786 $414.1430 (Partial Qualifying APM Participant (QP) election) Unchanged
221785 §414.1360 (Improvement Activities) Modified
221784 §414.1375 (Advancing Care Information Performance Category) Modified
221783 §414.1390 (Data Validation and Auditing) Removed
221782 §414.1400 QCDR and qualified registry self nomination Modified
221781 §414.1330 and §414.1335 CMS Web Interface Submission Mechanism Instruction Modified
221780 §414.1330 and §414.1335 EHR Submission Mechanism Modified
221779 §414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Modified
221777 §414.1330 and §414.1335 Claims Submission Mechanism Modified

ICR Details

Record metadata
OMB Control No0938-1314