Information Collection Request

Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

ICR 202007-0938-007 · OMB 0938-1314 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10621 MVP Candidates: Instructions and Template Form and Instruction New Available
Form CMS-10621 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Form Modified Available
Form CMS-10621 Measures under Consideration 2019, Data Template for Candidate Measures Form and Instruction Modified Available
Form CMS-10621 Data Template for Candidate Measures Form and Instruction Modified Available
Form CMS-10621 Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) Form Modified Available
Form CMS-10621 Promoting Interoperability Performance Category: Call for Measures Submission Form Form and Instruction Modified Available
Form CMS-10621 Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) Form and Instruction Modified Available
Form CMS-10621 Improvement Activities Performance Category: Call for Activities Submission Form Form Modified Available
Form CMS-10621 Extreme and Uncontrollable Circumstances Application Form Form Modified Available
Form CMS-10621 Hardship Exception Application Form Form Modified Repair queued
Form CMS-10621 2020 Qualified Clinical Data Registry (QCDR) Measure Submission Template Form Modified Available
CMS-10621 - Supporting Statement B (CMS-1734-P version 3).docx Supporting Statement B Uploaded 2020-08-21 Available
CMS-10621 - Supporting Statement A (CMS-1734-P version 4).docx Supporting Statement A Uploaded 2020-08-21 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
243257 Nomination of MVPs (SS-A Table 21) Form and Instruction NewMVP Candidates: Instructions and Template
243256 Open Authorization Credentialing and Token Request Process (SS-A Table 5) New
233582 Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 25) Form ModifiedSubmission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
233581 QPP Identity Management Application Process (see SS-A Table 9) Unchanged
229086 (Quality Performance Category) Call for Quality Measures (see SS-A Table 13) Form and Instruction ModifiedMeasures under Consideration 2019, Data Template for Candidate Measures
229086 (Quality Performance Category) Call for Quality Measures (see SS-A Table 13) Form and Instruction ModifiedData Template for Candidate Measures
229075 Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 24) Form ModifiedEligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
229074 (PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 17) Form and Instruction ModifiedPromoting Interoperability Performance Category: Call for Measures Submission Form
227511 (Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 26) Modified
227509 Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 23) Form and Instruction ModifiedOther Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
227507 (Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 20) Form ModifiedImprovement Activities Performance Category: Call for Activities Submission Form
227506 (PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 14) Form ModifiedExtreme and Uncontrollable Circumstances Application Form
227506 (PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 14) Form ModifiedHardship Exception Application Form
227505 (Quality Performance Category) Group Registration for CMS Web Interface (see SS-A Table 14) Instruction Removed
221786 Partial Qualifying APM Participant (QP) Election (see SS-A Table 22) Modified
221785 (Improvement Activities Performance Category) Data Submission (see SS-A Table 19) Modified
221784 (PI Performance Category) Data Submission (see SS-A Table 16) Modified
221782 Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4) Form Modified2020 Qualified Clinical Data Registry (QCDR) Measure Submission Template
221782 Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4) Instruction Modified
221781 (Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13) Removed
221780 (Quality Performance Category) eCQM Collection Type (see SS-A Table 12) Modified
221779 (Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11) Modified
221777 (Quality Performance Category) Claims Collection Type (see SS-A Table 10) Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2022 36 Months From Approved 01/31/2022
475,198 0 475,198
2,937,891 0 2,937,891
0 0 0





Reginfo record details
18
table that charts list of burden
IC Title Form No. Form Name
(Improvement Activities Performance Category) Data Submission (see SS-A Table 19)
(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 20) CMS-10621
(PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 17) CMS-10621
(PI Performance Category) Data Submission (see SS-A Table 16)
(PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 14) CMS-10621, CMS-10621 ,  
(Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 26)
(Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13)
(Quality Performance Category) Call for Quality Measures (see SS-A Table 13) CMS-10621, CMS-10621 ,  
(Quality Performance Category) Claims Collection Type (see SS-A Table 10)
(Quality Performance Category) Group Registration for CMS Web Interface (see SS-A Table 14)
(Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11)
(Quality Performance Category) eCQM Collection Type (see SS-A Table 12)
Nomination of MVPs (SS-A Table 21) CMS-10621
Open Authorization Credentialing and Token Request Process (SS-A Table 5)
Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 24) CMS-10621
Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 23) CMS-10621
Partial Qualifying APM Participant (QP) Election (see SS-A Table 22)
QPP Identity Management Application Process (see SS-A Table 9)
Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4) CMS-10621
Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 25) CMS-10621



Reginfo record details
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