Information Collection

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

IC 249142 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.