Information Collection

CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary

IC 250664 under ICR 202111-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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IC Title:	CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.1400 42 CFR 414.1325 42 CFR 414.1335 42 CFR 414.1380 42 CFR 414.1360 42 CFR 414.1430 42 CFR 414.1440 42 CFR 414.1375 42 CFR 414.1445 42 CFR 414.1395

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 119,923	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 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	322,970	322,970
Annual IC Time Burden (Hours)	1,390,019	1,390,019
Annual IC Cost Burden (Dollars)	0	0

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