2022 >> Quality Data Submission via the CMS Web Interface (SS-A Table 16)

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-10621 Quality Data Submission via the CMS Web Interface (SS-A Table 16) Form and Instruction
CMS-10621 2021 CMS Web Interface and CAHPS for MIPS Registration G Appendix N1 2022 CMS Web Interface and CAHPS for MIPS Registration Guide.pdf Form and Instruction
CMS-10621 2021 CMS Web Interface and CAHPS for MIPS Registration G Appendix N1 2022 CMS Web Interface and CAHPS for MIPS Registration Guide.pdf Form and Instruction
Appendix N2 2022 CMS Web Interface and CAHPS for MIPS Registration Guide Crosswalk.pdf CROSSWALK: 2021 CMS Web Interface and CAHPS for MIPS Registration Guide IC Document
Appendix N2 2022 CMS Web Interface and CAHPS for MIPS Registration Guide Crosswalk.pdf CROSSWALK: 2021 CMS Web Interface and CAHPS for MIPS Registration Guide IC Document

Information Collection (IC) Details

IC Title:	2022 >> Quality Data Submission via the CMS Web Interface (SS-A Table 16)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10621	2021 CMS Web Interface and CAHPS for MIPS Registration Guide	Appendix N1 2022 CMS Web Interface and CAHPS for MIPS Registration Guide.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 114	Number of Respondents for Small Entity: 114

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	114	114
Annual IC Time Burden (Hours)	7,030	7,030
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CROSSWALK: 2021 CMS Web Interface and CAHPS for MIPS Registration Guide	Appendix N2 2022 CMS Web Interface and CAHPS for MIPS Registration Guide Crosswalk.pdf	09/01/2021

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