?414.1400 QCDR and qualified registry self nomination

Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1314 can be found here:

Documents and Forms

Document Name Document Type
Appendix A_QPP_Qualified_Registry_Self-Nomination_Fact_Sheet.pdf Qualified Registry Self Nomination Fact Sheet IC Document
Appendix B_QPP_QCDR_Self-Nomination_Fact_Sheet.pdf QCDR Self Nomination Fact Sheet IC Document

Information Collection (IC) Details

IC Title:	§414.1400 QCDR and qualified registry self nomination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR §414.1400 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 233	Number of Respondents for Small Entity: 233

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	233	233
Annual IC Time Burden (Hours)	2,330	2,330
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Qualified Registry Self Nomination Fact Sheet	Appendix A_QPP_Qualified_Registry_Self-Nomination_Fact_Sheet.pdf	11/17/2017
QCDR Self Nomination Fact Sheet	Appendix B_QPP_QCDR_Self-Nomination_Fact_Sheet.pdf	11/17/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.