414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process

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

OMB: 0938-1314

IC ID: 229075

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414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process
 
No Unchanged
 
Mandatory
 
42 CFR 414.1445

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

Health Health Care Services

 

75 75
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 75 0 0 0 0 75
Annual IC Time Burden (Hours) 750 0 0 0 0 750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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