Information Collection

Quality Payment Program User Panel Registration Form (CMS-10807)

IC 253753 under ICR 202006-0938-020 · OMB 0938-1399.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1399 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10807 QPP User Panel Registration Form Quality Payment Program User Panel Registration Form (CMS-10807)	Form and Instruction
CMS-10807 QPP User Panel Registration Form CMS-10807 QPP User Panel Registration Form.docx	Form and Instruction
CMS-10807 QPP User Panel Registration Supporting Statement 5-20-22.docx CMS-10807 Supporting Statement	IC Document

IC Title:

Quality Payment Program User Panel Registration Form (CMS-10807)

Agency IC Tracking Number:

CCSQ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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-10807				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

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
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	1,660	1,660
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10807 Supporting Statement		05/20/2022

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

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