2023 > Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4)

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

OMB: 0938-1314

IC ID: 221782

Information Collection (IC) Details

View Information Collection (IC)

2023 > Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4)
 
No Modified
 
Mandatory
 
42 CFR 414.1400

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Appendix A1 2021 MIPS Qualified Registry Self-Nomination Fact Sheet_Updated.docx Yes Yes Printable Only
Instruction Appendix B1 2021 MIPS QCDR Self-Nomination Fact Sheet_Updated.docx Yes Yes Printable Only
Form CMS-10621 2021 Qualified Clinical Data Registry (QCDR) Measure Submission Template Appendix C1 2021 QCDR Measure Submission Template.xlsx Yes Yes Fillable Fileable

Health Health Care Services

Quality Payment Program (QPP), System No. 09–70– 0539  83 FR 6587

300 300
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 300 0 35 0 0 265
Annual IC Time Burden (Hours) 2,402 0 437 0 0 1,965
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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