Information Collection

CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary

IC 250664 under ICR 202311-0938-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 A1 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction
Appendix A1 2024 MIPS QCDR and Registry Self-nomination User Guide Appendix A1 2024 MIPS QCDR Registry Self-Nomination User Guide.pdf	Form and Instruction
Appendix A1 2024 MIPS QCDR and Registry Self-nomination User Guide Appendix A1 2024 MIPS QCDR Registry Self-Nomination User Guide.pdf	Form and Instruction
Appendix B1 2024 Submission Form for Other Payer Requests for Other Appendix B1 2024 Payer Initiated Submission Form.pdf	Form
Appendix B1 2024 Submission Form for Other Payer Requests for Other Appendix B1 2024 Payer Initiated Submission Form.pdf	Form
Appendix C1 2024 Submission Form for Eligible Clinician and APM Enti Appendix C1 2024 Eligible Clinician Initiated Submission Form.pdf	Form and Instruction
Appendix C1 2024 Submission Form for Eligible Clinician and APM Enti Appendix C1 2024 Eligible Clinician Initiated Submission Form.pdf	Form and Instruction
Appendix D1 2024 Submission Form for Requests for Qualifying Alterna Appendix D1 2024 All-Payer QP Data Submission Form.pdf	Form and Instruction
Appendix D1 2024 Submission Form for Requests for Qualifying Alterna Appendix D1 2024 All-Payer QP Data Submission Form.pdf	Form and Instruction
Appendix E Measures under Consideration 2023 Data Template for Cand Appendix E 2023 MUC Data Template.pdf	Form and Instruction
Appendix E Measures under Consideration 2023 Data Template for Cand Appendix E 2023 MUC Data Template.pdf	Form and Instruction
Appendix F 2023 Peer Reviewed Journal Article Requirement Template Appendix F 2023 MIPS Peer-Reviewed Journal Article Requirement Template.pdf	Form and Instruction
Appendix F 2023 Peer Reviewed Journal Article Requirement Template Appendix F 2023 MIPS Peer-Reviewed Journal Article Requirement Template.pdf	Form and Instruction
Appendix G1 Improvement Activities Performance Category, 2024 Call f Appendix G1 2024 IA Call for Activities Submission Form.pdf	Form and Instruction
Appendix G1 Improvement Activities Performance Category, 2024 Call f Appendix G1 2024 IA Call for Activities Submission Form.pdf	Form and Instruction
Appendix H1 2023 MIPS Promoting Interoperability Hardship Exception Appendix H1 2023 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	Form and Instruction
Appendix H1 2023 MIPS Promoting Interoperability Hardship Exception Appendix H1 2023 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	Form and Instruction
Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Excep Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide .pdf	Form and Instruction
Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Excep Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide .pdf	Form and Instruction
Appendix J1 2024 MVP Candidates: Instructions and Template Appendix J1 2024 MVP Development Standardized Template.pdf	Form and Instruction
Appendix J1 2024 MVP Candidates: Instructions and Template Appendix J1 2024 MVP Development Standardized Template.pdf	Form and Instruction
Appendix K1 2023 Partial QP Election Form Appendix K1 Partial QP Submission Form.pdf	Form and Instruction
Appendix K1 2023 Partial QP Election Form Appendix K1 Partial QP Submission Form.pdf	Form and Instruction
Appendix L 2023 MVP Registration Form Appendix L MVP Registration Form.xlsx	Form and Instruction
Appendix L 2023 MVP Registration Form Appendix L MVP Registration Form.xlsx	Form and Instruction
Appendix A2 2024 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf Crosswalk: Appendix A1	IC Document
Appendix A2 2024 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf Crosswalk: Appendix A1	IC Document
Appendix B2 2024 Payer Initiated Submission Form Crosswalk.pdf Crosswalk: Appendix B1	IC Document
Appendix B2 2024 Payer Initiated Submission Form Crosswalk.pdf Crosswalk: Appendix B1	IC Document
Appendix C2 2024 Eligible Clinician Initiated Submission Form Crosswalk.pdf Crosswalk: Appendix C1	IC Document
Appendix C2 2024 Eligible Clinician Initiated Submission Form Crosswalk.pdf Crosswalk: Appendix C1	IC Document
Appendix D2 2024 All-Payer QP Data Submission Form Crosswalk.pdf Crosswalk: Appendix D1	IC Document
Appendix D2 2024 All-Payer QP Data Submission Form Crosswalk.pdf Crosswalk: Appendix D1	IC Document
Appendix G2 2024 IA Call for Activities Crosswalk.pdf Crosswalk: Appendix G1	IC Document
Appendix G2 2024 IA Call for Activities Crosswalk.pdf Crosswalk: Appendix G1	IC Document
Appendix H2 2023 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf Crosswalk: Appendix H1	IC Document
Appendix H2 2023 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf Crosswalk: Appendix H1	IC Document
Appendix I2 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk .pdf Crosswalk: Appendix I1	IC Document
Appendix I2 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk .pdf Crosswalk: Appendix I1	IC Document
Appendix J2 2024 MVP Submission Template Crosswalk.pdf Crosswalk: Appendix J1	IC Document
Appendix J2 2024 MVP Submission Template Crosswalk.pdf Crosswalk: Appendix J1	IC Document
Appendix K2 Partial QP Submission Form Crosswalk.pdf Crosswalk: Appendix K1	IC Document
Appendix K2 Partial QP Submission Form Crosswalk.pdf Crosswalk: Appendix K1	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: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.1335 42 CFR 414.1380 42 CFR 414.1440 42 CFR 414.1360 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.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendix A1	2024 MIPS QCDR and Registry Self-nomination User Guide	Appendix A1 2024 MIPS QCDR Registry Self-Nomination User Guide.pdf	Yes	Yes	Fillable Fileable
Form	Appendix B1	2024 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)	Appendix B1 2024 Payer Initiated Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix C1	2024 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)	Appendix C1 2024 Eligible Clinician Initiated Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix D1	2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option	Appendix D1 2024 All-Payer QP Data Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix E	Measures under Consideration 2023 Data Template for Candidate Measures	Appendix E 2023 MUC Data Template.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix F	2023 Peer Reviewed Journal Article Requirement Template	Appendix F 2023 MIPS Peer-Reviewed Journal Article Requirement Template.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix G1	Improvement Activities Performance Category, 2024 Call for Activities Submission Form	Appendix G1 2024 IA Call for Activities Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix H1	2023 MIPS Promoting Interoperability Hardship Exception Application Guide	Appendix H1 2023 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix I1	2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide	Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide .pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix J1	2024 MVP Candidates: Instructions and Template	Appendix J1 2024 MVP Development Standardized Template.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix K1	2023 Partial QP Election Form	Appendix K1 Partial QP Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix L	2023 MVP Registration Form	Appendix L MVP Registration Form.xlsx	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: 191,225

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
	Approved	Program Change Due to New Statute	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	191,225	1,365	30,332	159,528
Annual IC Time Burden (Hours)	728,142	-4,147	18,429	713,860
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk: Appendix A1	Appendix A2 2024 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf	11/16/2023
Crosswalk: Appendix B1	Appendix B2 2024 Payer Initiated Submission Form Crosswalk.pdf	11/16/2023
Crosswalk: Appendix C1	Appendix C2 2024 Eligible Clinician Initiated Submission Form Crosswalk.pdf	11/16/2023
Crosswalk: Appendix D1	Appendix D2 2024 All-Payer QP Data Submission Form Crosswalk.pdf	11/16/2023
Crosswalk: Appendix G1	Appendix G2 2024 IA Call for Activities Crosswalk.pdf	11/16/2023
Crosswalk: Appendix H1	Appendix H2 2023 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf	11/16/2023
Crosswalk: Appendix I1	Appendix I2 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk .pdf	11/16/2023
Crosswalk: Appendix J1	Appendix J2 2024 MVP Submission Template Crosswalk.pdf	11/16/2023
Crosswalk: Appendix K1	Appendix K2 Partial QP Submission Form Crosswalk.pdf	11/16/2023

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