?414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process

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

OMB: 0938-1314

IC ID: 227509

Information Collection (IC) Details

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§414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process
 
No Modified
 
Mandatory
 
42 CFR 414.1440

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10621 Clinician Initiated Submission Form Appendix D Clinician Initiated Submission Form (CR)_final_.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10621 Payer Initiated Submission Form Appendix E Payer Initiated Submission Form (07-02-18)_clean.docx Yes Yes Fillable Fileable

Health Health Care Services

 

165 165
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 165 0 0 -135 0 300
Annual IC Time Burden (Hours) 1,650 0 0 -1,350 0 3,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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