Information Collection

2023 > Nomination of MVPs (SS-A Table 28)

IC 245229 under ICR 202107-0938-013 · OMB 0938-1314.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1314 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10621 Nomination of MVPs (SS-A Table 28)	Form and Instruction
CMS-10621 Stakeholder Submissions of MIPS Value Pathways (MVP) Can Appendix M MVP Development Standardized Template.pdf	Form and Instruction
CMS-10621 Stakeholder Submissions of MIPS Value Pathways (MVP) Can Appendix M MVP Development Standardized Template.pdf	Form and Instruction

IC Title:

2023 > Nomination of MVPs (SS-A Table 28)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-10621	Stakeholder Submissions of MIPS Value Pathways (MVP) Candidates: Instructions and Template	Appendix M MVP Development Standardized Template.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

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
	Requested	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.