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

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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. 09–70– 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 %

	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

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.