Information Collection Request

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

ICR 202307-0938-005 · OMB 0938-1314 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) (previously Appendix I) Form and Instruction New Available
Form Appendix G Improvement Activities Performance Category, 2023 Call for Activities Submission Form (previously Appendix H) Form and Instruction New Repair queued
Form Appendix K 2022 Partial QP Election Form (for submission in CY 2023) (previously Appendix L) Form and Instruction New Available
Form Appendix J 2023 MVP Candidates: Instructions and Template (previously Appendix K) Form and Instruction New Available
Form Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Form and Instruction New Available
Form Appendix E1 Measures under Consideration 2023 Data Template for Candidate Measures Form and Instruction New Repair queued
Form Appendix D 2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Form and Instruction New Available
Form Appendix C Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) Form and Instruction New Repair queued
Form Appendix B 2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) Form and Instruction New Available
Form Appendix I 2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY 2023) (previously Appendix J) Form and Instruction New Available
Form Appendix L 2023 MVP Registration Form (New) Form New Available
Form Appendix A 2023 QCDR and Registry Self-nomination User Guide Form and Instruction New Available
Form Appendix A CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New Repair queued
Form Appendix L1 2022 Partial QP Election Form (for submission in CY 2023) Form and Instruction Removed Available
Form Appendix K1 2023 MVP Candidates: Instructions and Template Form and Instruction Removed Available
Form Appendix J 2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY2023 Form and Instruction Removed Available
Form Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) Form and Instruction Removed Available
Form Appendix H1 Improvement Activities Performance Category, 2023 Call for Activities Submission Form Form and Instruction Removed Available
Form Appendix G1 Promoting Interoperability Performance Category, 2023 Call for Measures Submission Form Form and Instruction Removed Repair queued
Form Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Form and Instruction Removed Available
Form Appendix E1 Measures under Consideration 2022 (for the 2024 performance period), Data Template for Candidate Measures Form and Instruction Removed Available
Form Appendix D1 2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Form and Instruction Removed Available
Form Appendix C1 2023 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) Form and Instruction Removed Available
Form Appendix B1 2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) Form Removed Repair queued
Form Appendix A Self-Nomination User Guide for Qualified Clinical Data Registries (QCDRs) and Qualified Registries Form and Instruction Removed Available
Form Appendix A CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed Repair queued
CMS-10621 - Supporting Statement A (CMS-1784-P version 5).docx Supporting Statement A Uploaded 2023-08-24 Repair queued
CMS-10621-Supporting Statement B (CMS-1784-P version 2).docx Supporting Statement B Uploaded 2023-07-10 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) (previously Appendix I)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction NewImprovement Activities Performance Category, 2023 Call for Activities Submission Form (previously Appendix H)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2022 Partial QP Election Form (for submission in CY 2023) (previously Appendix L)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2023 MVP Candidates: Instructions and Template (previously Appendix K)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2023 Peer Reviewed Journal Article Requirement Template
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction NewMeasures under Consideration 2023 Data Template for Candidate Measures
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction NewSubmission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY 2023) (previously Appendix J)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form New2023 MVP Registration Form (New)
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New2023 QCDR and Registry Self-nomination User Guide
261023 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction New
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed2022 Partial QP Election Form (for submission in CY 2023)
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed2023 MVP Candidates: Instructions and Template
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY2023
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023)
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction RemovedImprovement Activities Performance Category, 2023 Call for Activities Submission Form
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction RemovedPromoting Interoperability Performance Category, 2023 Call for Measures Submission Form
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed2023 Peer Reviewed Journal Article Requirement Template
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction RemovedMeasures under Consideration 2022 (for the 2024 performance period), Data Template for Candidate Measures
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed2023 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form Removed2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction RemovedSelf-Nomination User Guide for Qualified Clinical Data Registries (QCDRs) and Qualified Registries
250664 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2025 36 Months From Approved 01/31/2025
159,528 0 159,528
713,860 0 713,860
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Appendix D1, Appendix A, Appendix B1, Appendix E1, Appendix F1, Appendix G1, Appendix H1, Appendix K1, Appendix L1, Appendix C1, Appendix I, Appendix J ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,  
CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Appendix A, Appendix B, Appendix C, Appendix D, Appendix E1, Appendix F1, Appendix G, Appendix H, Appendix I, Appendix J, Appendix K, Appendix L ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,  



Reginfo record details
  No