Information Collection

CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary

IC 261023 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⚠️ Notice: This information collection may be referencing outdated material.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 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction
Appendix A 2023 QCDR and Registry Self-nomination User Guide Appendix A 2023MIPS QCDR and Registry Self-Nomination User Guide.docx	Form and Instruction
Appendix A 2023 QCDR and Registry Self-nomination User Guide Appendix A 2023MIPS QCDR and Registry Self-Nomination User Guide.docx	Form and Instruction
Appendix L 2023 MVP Registration Form (New) Appendix L MVP Registration Form.xlsx	Form
Appendix L 2023 MVP Registration Form (New) Appendix L MVP Registration Form.xlsx	Form
Appendix I 2022 MIPS Extreme and Uncontrollable Circumstances Excep Appendix I 2022 Extreme and Uncontrollable Circumstances Exception Application Guide.pptx	Form and Instruction
Appendix I 2022 MIPS Extreme and Uncontrollable Circumstances Excep Appendix I 2022 Extreme and Uncontrollable Circumstances Exception Application Guide.pptx	Form and Instruction
Appendix B 2023 Submission Form for Other Payer Requests for Other Appendix B 2023 Payer Initiated Submission Form.docx	Form and Instruction
Appendix B 2023 Submission Form for Other Payer Requests for Other Appendix B 2023 Payer Initiated Submission Form.docx	Form and Instruction
Appendix C Submission Form for Eligible Clinician and APM Entity Re Appendix C 2023 Eligible Clinician Initiated Submission Form.docx	Form and Instruction
Appendix C Submission Form for Eligible Clinician and APM Entity Re Appendix C 2023 Eligible Clinician Initiated Submission Form.docx	Form and Instruction
Appendix D 2023 Submission Form for Requests for Qualifying Alterna Appendix D 2023 All-Payer QP Data Submission Form.docx	Form and Instruction
Appendix D 2023 Submission Form for Requests for Qualifying Alterna Appendix D 2023 All-Payer QP Data Submission Form.docx	Form and Instruction
Appendix E1 Measures under Consideration 2023 Data Template for Cand Appendix E1 2023 MUC Data Template.docx	Form and Instruction
Appendix E1 Measures under Consideration 2023 Data Template for Cand Appendix E1 2023 MUC Data Template.docx	Form and Instruction
Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Appendix F1 2023 MIPS Peer-Reviewed Journal Article Requirement Template.docx	Form and Instruction
Appendix F1 2023 Peer Reviewed Journal Article Requirement Template Appendix F1 2023 MIPS Peer-Reviewed Journal Article Requirement Template.docx	Form and Instruction
Appendix J 2023 MVP Candidates: Instructions and Template (previous Appendix J 2023 MVP Development Standardized Template v2.docx	Form and Instruction
Appendix J 2023 MVP Candidates: Instructions and Template (previous Appendix J 2023 MVP Development Standardized Template v2.docx	Form and Instruction
Appendix K 2022 Partial QP Election Form (for submission in CY 2023 Appendix K Partial QP Submission Form.docx	Form and Instruction
Appendix K 2022 Partial QP Election Form (for submission in CY 2023 Appendix K Partial QP Submission Form.docx	Form and Instruction
Appendix G Improvement Activities Performance Category, 2023 Call f Appendix G 2023 IA Call for Activities Submission Form.docx	Form and Instruction
Appendix G Improvement Activities Performance Category, 2023 Call f Appendix G 2023 IA Call for Activities Submission Form.docx	Form and Instruction
Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	Form and Instruction
Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	Form and Instruction
Appendix E2 2023 MUC Data Template Crosswalk.docx Crosswalk - Appendix E2: Measures under Consideration 2023 Data Template for Candidate Measures	IC Document
Appendix E2 2023 MUC Data Template Crosswalk.docx Crosswalk - Appendix E2: Measures under Consideration 2023 Data Template for Candidate Measures	IC Document
Appendix F2 2023 MIPS Peer-Reviewed Journal Article Requirement Template Crosswalk.docx Crosswalk - Appendix F2: 2023 Peer Reviewed Journal Article Requirement Template	IC Document
Appendix F2 2023 MIPS Peer-Reviewed Journal Article Requirement Template Crosswalk.docx Crosswalk - Appendix F2: 2023 Peer Reviewed Journal Article Requirement Template	IC Document
Appendix E3 - Track Change (2023 MUC Data Template).docx Track Change - Appendix E3: Measures under Consideration 2023 Data Template for Candidate Measures	IC Document
Appendix E3 - Track Change (2023 MUC Data Template).docx Track Change - Appendix E3: Measures under Consideration 2023 Data Template for Candidate Measures	IC Document
Appendix F3 - Track Change (2023 MIPS Peer-Reviewed Journal Article Requirement Template).docx Track Change - Appendix F3: 2023 Peer Reviewed Journal Article Requirement Template	IC Document
Appendix F3 - Track Change (2023 MIPS Peer-Reviewed Journal Article Requirement Template).docx Track Change - Appendix F3: 2023 Peer Reviewed Journal Article Requirement Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

CY 2024 Performance Period/2026 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 414.1335 42 CFR 414.1380 42 CFR 414.1445 42 CFR 414.1360 42 CFR 414.1395 42 CFR 414.1430 42 CFR 414.1400 42 CFR 414.1325 42 CFR 414.1375 42 CFR 414.1440

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendix A	2023 QCDR and Registry Self-nomination User Guide	Appendix A 2023MIPS QCDR and Registry Self-Nomination User Guide.docx	Yes	Yes	Fillable Fileable
Form	Appendix L	2023 MVP Registration Form (New)	Appendix L MVP Registration Form.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix I	2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY 2023) (previously Appendix J)	Appendix I 2022 Extreme and Uncontrollable Circumstances Exception Application Guide.pptx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix B	2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)	Appendix B 2023 Payer Initiated Submission Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix C	Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)	Appendix C 2023 Eligible Clinician Initiated Submission Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix D	2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option	Appendix D 2023 All-Payer QP Data Submission Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix E1	Measures under Consideration 2023 Data Template for Candidate Measures	Appendix E1 2023 MUC Data Template.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix F1	2023 Peer Reviewed Journal Article Requirement Template	Appendix F1 2023 MIPS Peer-Reviewed Journal Article Requirement Template.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix J	2023 MVP Candidates: Instructions and Template (previously Appendix K)	Appendix J 2023 MVP Development Standardized Template v2.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix K	2022 Partial QP Election Form (for submission in CY 2023) (previously Appendix L)	Appendix K Partial QP Submission Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix G	Improvement Activities Performance Category, 2023 Call for Activities Submission Form (previously Appendix H)	Appendix G 2023 IA Call for Activities Submission Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix H	2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) (previously Appendix I)	Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	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: 184,564

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
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	184,564	1,284	159,528	23,752
Annual IC Time Burden (Hours)	715,450	-4,002	713,860	5,592
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk - Appendix E2: Measures under Consideration 2023 Data Template for Candidate Measures	Appendix E2 2023 MUC Data Template Crosswalk.docx	08/24/2023
Crosswalk - Appendix F2: 2023 Peer Reviewed Journal Article Requirement Template	Appendix F2 2023 MIPS Peer-Reviewed Journal Article Requirement Template Crosswalk.docx	08/24/2023
Track Change - Appendix E3: Measures under Consideration 2023 Data Template for Candidate Measures	Appendix E3 - Track Change (2023 MUC Data Template).docx	08/24/2023
Track Change - Appendix F3: 2023 Peer Reviewed Journal Article Requirement Template	Appendix F3 - Track Change (2023 MIPS Peer-Reviewed Journal Article Requirement Template).docx	08/24/2023

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