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Form CMS-10621 Clinician Initiated Submission Form
Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)
Appendix D Clinician Initiated Submission Form (CR)_final
?414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process
OMB: 0938-1314
OMB.report
HHS/CMS
OMB 0938-1314
ICR 201807-0938-013
IC 227509
Form CMS-10621 Clinician Initiated Submission Form
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1314 can be found here:
2023-11-17 - Revision of a currently approved collection
2023-08-24 - Revision of a currently approved collection
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