(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 22)

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

OMB: 0938-1314

IC ID: 227507

Information Collection (IC) Details

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(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 22)
 
No Modified
 
Mandatory
 
42 CFR 414.1360

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10621 Improvement Activities Performance Category: Call for Activities Submission Form Appendix I 2019 IA Call for Activities Submission Form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

125 125
   
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 125 0 0 -25 0 150
Annual IC Time Burden (Hours) 250 0 0 175 0 75
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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