CMS-10805 and CMS-10806

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

OMB: 0938-1399

IC ID: 252213

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

CMS-10805 and CMS-10806 CSQ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10805 Submissions Experience Survey CMS-10805 QPP Submissions Experience Survey.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10806 Presubmissions experience survey CMS-10806 QPP Presubmissions experience survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

3,000 0
   
Private Sector Businesses or other for-profits
 
   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 3,000 0 3,000 0 0 0
Annual IC Time Burden (Hours) 750 0 750 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10805 Supporting Statement CMS-10805 2021 QPP Submissions Experience Survey Supporting Statement 3-4-22.docx 03/16/2022
CMS-10806 Supporting Statement CMS-10806 2022 QPP Pre Submission Survey Supporting Statement 3-4-22.docx 03/16/2022
Burden Table CMS-10805 and CMS-10806 Burden table.docx 03/16/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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