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Appendix B1 2023 Submission Form for Other Payer Requests for Other
Quality Payment Program (QPP)/Merit-Based Incentive Payment System (MIPS) (CMS-10621)
Appendix B1 2023 Payer Initiated Submission Form
CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary
OMB: 0938-1314
OMB.report
HHS/CMS
OMB 0938-1314
ICR 202301-0938-017
IC 250664
Appendix B1 2023 Submission Form for Other Payer Requests for Other
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1314 can be found here:
2023-11-17 - Revision of a currently approved collection
2023-08-24 - Revision of a currently approved collection
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