Information Collection

CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary

IC 250664 under ICR 202307-0938-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Appendix A CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix A Self-Nomination User Guide for Qualified Clinical Data Registries (QCDRs) and Qualified Registries CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix B1 2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form
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) CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix D1 2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix E1 Measures under Consideration 2022 (for the 2024 performance period), Data Template for Candidate Measures CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix F1 2023 Peer Reviewed Journal Article Requirement Template CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix G1 Promoting Interoperability Performance Category, 2023 Call for Measures Submission Form CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix H1 Improvement Activities Performance Category, 2023 Call for Activities Submission Form CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix J 2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY2023 CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix K1 2023 MVP Candidates: Instructions and Template CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Form Appendix L1 2022 Partial QP Election Form (for submission in CY 2023) CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Form and Instruction
Appendix A Self-Nomination User Guide for Qualified Clinical Data R Appendix A 2023MIPS QCDR and Registry Self-Nomination User Guide.docx	Form and Instruction
Appendix A Self-Nomination User Guide for Qualified Clinical Data R Appendix A 2023MIPS QCDR and Registry Self-Nomination User Guide.docx	Form and Instruction
Appendix B1 2023 Submission Form for Other Payer Requests for Other Appendix B1 2023 Payer Initiated Submission Form.pdf	Form
Appendix B1 2023 Submission Form for Other Payer Requests for Other Appendix B1 2023 Payer Initiated Submission Form.pdf	Form
Appendix C1 2023 Submission Form for Eligible Clinician and APM Enti Appendix C1 2023 Eligible Clinician Initiated Submission Form.docx	Form and Instruction
Appendix C1 2023 Submission Form for Eligible Clinician and APM Enti Appendix C1 2023 Eligible Clinician Initiated Submission Form.docx	Form and Instruction
Appendix D1 2023 Submission Form for Requests for Qualifying Alterna Appendix D1 2023 All-Payer QP Data Submission Form.docx	Form and Instruction
Appendix D1 2023 Submission Form for Requests for Qualifying Alterna Appendix D1 2023 All-Payer QP Data Submission Form.docx	Form and Instruction
Appendix E1 Measures under Consideration 2022 (for the 2024 performa Appendix E1 2022 MUC Data Template.docx	Form and Instruction
Appendix E1 Measures under Consideration 2022 (for the 2024 performa Appendix E1 2022 MUC Data Template.docx	Form and Instruction
Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Appendix F1 2022 MIPS Peer-Reviewed Journal Article Requirement Template.docx	Form and Instruction
Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Appendix F1 2022 MIPS Peer-Reviewed Journal Article Requirement Template.docx	Form and Instruction
Appendix G1 Promoting Interoperability Performance Category, 2023 Ca Appendix G1 2023 PI Call for Measures Submission Form.pdf	Form and Instruction
Appendix G1 Promoting Interoperability Performance Category, 2023 Ca Appendix G1 2023 PI Call for Measures Submission Form.pdf	Form and Instruction
Appendix H1 Improvement Activities Performance Category, 2023 Call f Appendix H1 2023 IA Call for Activities Submission Form.docx	Form and Instruction
Appendix H1 Improvement Activities Performance Category, 2023 Call f Appendix H1 2023 IA Call for Activities Submission Form.docx	Form and Instruction
Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	Form and Instruction
Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	Form and Instruction
Appendix J 2022 MIPS Extreme and Uncontrollable Circumstances Excep Appendix J 2022 Extreme and Uncontrollable Circumstances Exception Application Guide.pptx	Form and Instruction
Appendix J 2022 MIPS Extreme and Uncontrollable Circumstances Excep Appendix J 2022 Extreme and Uncontrollable Circumstances Exception Application Guide.pptx	Form and Instruction
Appendix K1 2023 MVP Candidates: Instructions and Template Appendix K1 2023 MVP Development Standardized Template v2.docx	Form and Instruction
Appendix K1 2023 MVP Candidates: Instructions and Template Appendix K1 2023 MVP Development Standardized Template v2.docx	Form and Instruction
Appendix L1 2022 Partial QP Election Form (for submission in CY 2023 Appendix L1 Partial QP Submission Form.docx	Form and Instruction
Appendix L1 2022 Partial QP Election Form (for submission in CY 2023 Appendix L1 Partial QP Submission Form.docx	Form and Instruction
Appendix B2 2023 Payer Initiated Submission Form Crosswalk.docx Crosswalk: Appendix B1	IC Document
Appendix B2 2023 Payer Initiated Submission Form Crosswalk.docx Crosswalk: Appendix B1	IC Document
Appendix C2 2023 Eligible Clinician Initiated Submission Form Crosswalk.docx Crosswalk: Appendix C1	IC Document
Appendix C2 2023 Eligible Clinician Initiated Submission Form Crosswalk.docx Crosswalk: Appendix C1	IC Document
Appendix D2 2023 All-Payer QP Data Submission Form Crosswalk.docx Crosswalk: Appendix D1	IC Document
Appendix D2 2023 All-Payer QP Data Submission Form Crosswalk.docx Crosswalk: Appendix D1	IC Document
Appendix E2 2022 MUC Data Template Crosswalk.docx Crosswalk: Appendix E1	IC Document
Appendix E2 2022 MUC Data Template Crosswalk.docx Crosswalk: Appendix E1	IC Document
Appendix F2 2022 MIPS Peer-Reviewed Journal Article Requirement Template Crosswalk.docx Crosswalk: Appendix F1	IC Document
Appendix F2 2022 MIPS Peer-Reviewed Journal Article Requirement Template Crosswalk.docx Crosswalk: Appendix F1	IC Document
Appendix G2 2023 PI Call for Measures Submission Form Crosswalk.docx Crosswalk: Appendix G1	IC Document
Appendix G2 2023 PI Call for Measures Submission Form Crosswalk.docx Crosswalk: Appendix G1	IC Document
Appendix H2 2023 IA Call for Activities Crosswalk.docx Crosswalk: Appendix H1	IC Document
Appendix H2 2023 IA Call for Activities Crosswalk.docx Crosswalk: Appendix H1	IC Document
Appendix K2 2023 MVP Submission Template Crosswalk.pdf Crosswalk: Appendix K1	IC Document
Appendix K2 2023 MVP Submission Template Crosswalk.pdf Crosswalk: Appendix K1	IC Document
Appendix L2 2022 Partial QP Submission Form Crosswalk.docx Crosswalk: Appendix L1	IC Document
Appendix L2 2022 Partial QP Submission Form Crosswalk.docx Crosswalk: Appendix L1	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendix A	Yes	Yes	Fillable Fileable
Form	Appendix B1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix C1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix D1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix E1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix F1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix G1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix H1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix I	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix J	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix K1	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix L1	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 159,528

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 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-159,528	159,528
Annual IC Time Burden (Hours)	-713,860	713,860
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk: Appendix B1		01/25/2023
Crosswalk: Appendix C1		01/25/2023
Crosswalk: Appendix D1		01/25/2023
Crosswalk: Appendix E1		01/25/2023
Crosswalk: Appendix F1		01/25/2023
Crosswalk: Appendix G1		01/25/2023
Crosswalk: Appendix H1		01/25/2023
Crosswalk: Appendix K1		01/25/2023
Crosswalk: Appendix L1		01/25/2023

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

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