Information Collection

(Quality Performance Category) Call for Quality Measures (see SS-A Table 15)

IC 229086 under ICR 201911-0938-009 · OMB 0938-1314.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10621 (Quality Performance Category) Call for Quality Measures (see SS-A Table 15)	Form and Instruction
CMS-10621 Data Template for Candidate Measures Appendix N MUC Template Blank 2019 to 508.docx	Form and Instruction
CMS-10621 Measures under Consideration 2019, Data Template for Can Appendix T 2020 MIPS Peer Reviewed Journal Article Template.docx	Form and Instruction
Appendix O MUC Template Crosswalk.docx Crosswalk: Data Template for Candidate Measures	IC Document

IC Title:

(Quality Performance Category) Call for Quality Measures (see SS-A Table 15)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.1330

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10621	Data Template for Candidate Measures	Appendix N MUC Template Blank 2019 to 508.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10621	Measures under Consideration 2019, Data Template for Candidate Measures	Appendix T 2020 MIPS Peer Reviewed Journal Article Template.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Quality Payment Program (QPP), System No. 09â70â 0539

FR Citation: 83 FR 6587

Number of Respondents: 28

Number of Respondents for Small Entity: 28

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	28	-112	0	140
Annual IC Time Burden (Hours)	154	28	-504	630
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk: Data Template for Candidate Measures	Appendix O MUC Template Crosswalk.docx	11/22/2019

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