(CMS-10695) Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10860 QPP Feedback Survey	Form and Instruction	New	Repair queued
Form CMS-10898 Non-participating Small and Solo Practices Survey Instrument	Form and Instruction	New	Repair queued
Form CMS-10899 MVP Registration Survey	Form and Instruction	New	Repair queued
Form CMS-10850 Submissions Experience Survey	Form and Instruction	New	Repair queued
Form CMS-10850 PY23 Submission Experience Survey	Form and Instruction	New	Repair queued
Form CMS-10862 Post Webinar Presentation Satisfaction Survey	Form and Instruction	New	Repair queued
Form CMS-10860 QPP Feedback Survey	Form and Instruction	New	Repair queued
Form CMS-10850 QPP Submissions Experience Survey	Form and Instruction	New	Repair queued
Form CMS-10807 QPP User Panel Registration Form	Form and Instruction	New	Repair queued
Form CMS-10806 Presubmissions experience survey	Form and Instruction	New	Available
Form CMS-10805 Submissions Experience Survey	Form and Instruction	New	Available
CMS-10695 Response_to_Public_Comments.docx	Supplementary Document	Uploaded 2020-07-01	Repair queued
CMS-10695 MIPS Survey Supporting Statement A_03-27-2020.docx	Supporting Statement A	Uploaded 2020-07-01	Repair queued
CMS-10695 MIPS Survey Supporting Statement B_032720.docx	Supporting Statement B	Uploaded 2020-06-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
268032	Quality Payment Program Annual Performance Feedback Survey (CMS-10860 revised)	Form and Instruction	New	QPP Feedback Survey
266730	Non-participating Small and Solo Practice Survey (CMS-10898)	Form and Instruction	New	Non-participating Small and Solo Practices Survey Instrument
266729	Quality Payment Program MVP Registration Feedback Survey (CMS-10899)	Form and Instruction	New	MVP Registration Survey
264009	2024 QPP Submissions Experience Survey (CMS-10850)	Form and Instruction	New	Submissions Experience Survey
264009	2024 QPP Submissions Experience Survey (CMS-10850)	Form and Instruction	New	PY23 Submission Experience Survey
260781	Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Post Webinar Presentation Satisfaction Survey (CMS-10862)	Form and Instruction	New	Post Webinar Presentation Satisfaction Survey
260405	Quality Payment Program Annual Performance Feedback Survey (CMS-10860)	Form and Instruction	New	QPP Feedback Survey
259058	2023 QPP Submissions Experience Survey (CMS-10850)	Form and Instruction	New	QPP Submissions Experience Survey
253753	Quality Payment Program User Panel Registration Form (CMS-10807)	Form and Instruction	New	QPP User Panel Registration Form
252213	CMS-10805 and CMS-10806	Form and Instruction	New	Presubmissions experience survey
252213	CMS-10805 and CMS-10806	Form and Instruction	New	Submissions Experience Survey

ICR Details

OMB Control No: 0938-1399	ICR Reference No: 202006-0938-020
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: (CMS-10695) Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/09/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/01/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved
Responses	630,300	0	0
Time Burden (Hours)	57,950	0	0
Cost Burden (Dollars)	5,328,024	0	0

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Abstract: This generic clearance is for a program of survey and feedback collections supporting the Quality Payment Program which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs). This clearance is necessary to enable CMS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improve quality and reduce complexity and burden. The information collected from MIPS eligible clinicians, third-party intermediaries, Medicare beneficiaries, and any other audiences that would support CMS in improving MIPS or the Quality Payment Program will help ensure that all stakeholders have an effective and efficient experience. This feedback will help improve user experience, assess methods for simplifying participation including data submission, improve and enhance the utility of web-based tools, and increase the effectiveness of communication with stakeholders.

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Authorizing Statute(s): US Code: 42 USC 1395w-4(s) Name of Law: Merit Based Incentive Program
   PL: Pub.L. 114 - 10 101 Name of Law: MACRA
   PL: Pub.L. 114 - 255 4002(b)(1)(b) Name of Law: 21st Century Cures Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 21010	06/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 39570	07/01/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
2023 QPP Submissions Experience Survey (CMS-10850)	CMS-10850	QPP Submissions Experience Survey
2024 QPP Submissions Experience Survey (CMS-10850)	CMS-10850, CMS-10850	PY23 Submission Experience Survey ,   Submissions Experience Survey
CMS-10805 and CMS-10806	CMS-10805, CMS-10806	Submissions Experience Survey ,   Presubmissions experience survey
Non-participating Small and Solo Practice Survey (CMS-10898)	CMS-10898	Non-participating Small and Solo Practices Survey Instrument
Quality Payment Program MVP Registration Feedback Survey (CMS-10899)	CMS-10899	MVP Registration Survey
Quality Payment Program Annual Performance Feedback Survey (CMS-10860 revised)	CMS-10860	QPP Feedback Survey
Quality Payment Program Annual Performance Feedback Survey (CMS-10860)	CMS-10860	QPP Feedback Survey
Quality Payment Program User Panel Registration Form (CMS-10807)	CMS-10807	QPP User Panel Registration Form
Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Post Webinar Presentation Satisfaction Survey (CMS-10862)	CMS-10862	Post Webinar Presentation Satisfaction Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	630,300	0	0	630,300	0	0
Annual Time Burden (Hours)	57,950	0	0	57,950	0	0
Annual Cost Burden (Dollars)	5,328,024	0	0	5,328,024	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new Generic.

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Annual Cost to Federal Government: $3,525,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/01/2020

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