Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections (CMS-10695)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10969 2026 Resource Library Assistant User Feedback Survey	Form and Instruction	New	Repair queued
Form CMS-10933R MVP Adoption Survey	Form and Instruction	New	Repair queued
Form CMS-10860 Revision PY25 QPP Feedback Survey Guide	Form and Instruction	New	Repair queued
Form CMS-10850 Revised QPP Submissions Experience Survey	Form and Instruction	New	Repair queued
Form CMS-10860 QPP Feedback Survey	Form and Instruction	New	Repair queued
Form CMS-10933 MVP Adoption Survey	Form and Instruction	New	Repair queued
Form CMS-10925 QPP Participation and Performance Resource Page Intercept Survey	Form and Instruction	New	Repair queued
Form CMS-10807 revised QPP User Panel Registration Form	Form and Instruction	New	Repair queued
Form CmS-10921 Electronic Prescribing of Controlled Substances Intercept Survey	Form and Instruction	New	Repair queued
Form CMS-10850 QPP Submissions Experience Survey	Form and Instruction	New	Repair queued
Form CMS-10917 QPP Web Content Generic Intercept Survey	Form and Instruction	New	Repair queued
Form CMS-10899 QPP MVP Registration Survey	Form and Instruction	New	Available
Form CMS-10899 Quality Payment Program MVP Registration Feedback Survey (CMS-10899)	Form and Instruction	New	Missing upstream
Form CMS-10898 Non-participating Small and Solo Practices Survey	Form and Instruction	New	Available
Form CMS-10898 Non-participating Small and Solo Practice Survey (CMS-10898)	Form and Instruction	New	Repair queued
Form CMS-10862 QPP/MIPS Post Webinar Presentation Satisfaction Survey	Form and Instruction	New	Available
Form CMS-10862 QPP/MIPS Post Webinar Presentation Satisfaction Survey (CMS-10862)	Form and Instruction	New	Missing upstream
Form CMS-10860 QPP Feedback Survey	Form and Instruction	New	Available
Form CMS-10860 Quality Payment Program Annual Performance Feedback Survey (CMS-10860)	Form and Instruction	New	Missing upstream
Form CMS-10807 QPP User Panel Registration Form	Form and Instruction	New	Available
Form CMS-10807 Quality Payment Program User Panel Registration Form (CMS-10807)	Form and Instruction	New	Available
CMS-10695 MIPS Survey Supporting Statement A_8-8-24.docx	Supporting Statement A	Uploaded 2024-08-09	Repair queued
CMS-10695 MIPS Survey Supporting Statement A_8-8-24.docx	Supporting Statement A	Uploaded 2024-08-09	Repair queued
CMS-10695 Supporting Statement Part B Research.docx	Supporting Statement B	Uploaded 2024-08-01	Available
CMS-10695 Supporting Statement Part B Research.docx	Supporting Statement B	Uploaded 2024-08-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
281229	2026 Resource Library Assistant User Feedback Survey (CMS-10969)	Form and Instruction	New	2026 Resource Library Assistant User Feedback Survey
280707	MVP Adoption Survey (CMS-10933Revised)	Form and Instruction	New	MVP Adoption Survey
280056	PY25 QPP Annual Performance Feedback Survey (CMS-10860 Revision 2)	Form and Instruction	New	PY25 QPP Feedback Survey Guide
279746	PY25 QPP Submissions Experience Survey (CMS-10850) Revised	Form and Instruction	New	QPP Submissions Experience Survey
277079	Quality Payment Program Annual Performance Feedback Survey (CMS-10860 revised)	Form and Instruction	New	QPP Feedback Survey
277078	MVP Adoption Survey (CMS-10933)	Form and Instruction	New	MVP Adoption Survey
277077	QPP Participation and Performance Resource Page Intercept Survey (CMS-10925)	Form and Instruction	New	QPP Participation and Performance Resource Page Intercept Survey
275353	Quality Payment Program User Panel Registration Form (CMS-10807 revised))	Form and Instruction	New	QPP User Panel Registration Form
273890	CMS Electronic Prescribing of Controlled Substances Intercept Survey Intercept Survey (CMS-10921)	Form and Instruction	New	Electronic Prescribing of Controlled Substances Intercept Survey
273179	PY24 QPP Submissions Experience Survey (CMS-10850)	Form and Instruction	New	QPP Submissions Experience Survey
272469	QPP Web Content Generic Intercept Survey (CMS-10917)	Form and Instruction	New	QPP Web Content Generic Intercept Survey
270007	Quality Payment Program MVP Registration Feedback Survey (CMS-10899)	Form and Instruction	New	QPP MVP Registration Survey
270007	Quality Payment Program MVP Registration Feedback Survey (CMS-10899)	Form and Instruction	New
270006	Non-participating Small and Solo Practice Survey (CMS-10898)	Form and Instruction	New	Non-participating Small and Solo Practices Survey
270006	Non-participating Small and Solo Practice Survey (CMS-10898)	Form and Instruction	New
270004	QPP/MIPS Post Webinar Presentation Satisfaction Survey (CMS-10862)	Form and Instruction	New	QPP/MIPS Post Webinar Presentation Satisfaction Survey
270004	QPP/MIPS Post Webinar Presentation Satisfaction Survey (CMS-10862)	Form and Instruction	New
270000	Quality Payment Program Annual Performance Feedback Survey (CMS-10860)	Form and Instruction	New	QPP Feedback Survey
270000	Quality Payment Program Annual Performance Feedback Survey (CMS-10860)	Form and Instruction	New
269959	Quality Payment Program User Panel Registration Form (CMS-10807)	Form and Instruction	New	QPP User Panel Registration Form
269959	Quality Payment Program User Panel Registration Form (CMS-10807)	Form and Instruction	New

ICR Details

OMB Control No: 0938-1399	ICR Reference No: 202408-0938-002
Status: Active	Previous ICR Reference No: 202006-0938-020
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections (CMS-10695)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/15/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/12/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved	11/30/2024
Responses	630,300	0	630,300
Time Burden (Hours)	57,950	0	57,950
Cost Burden (Dollars)	5,328,024	0	5,328,024

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Abstract: This generic clearance is for a program of survey and feedback collections supporting the Quality Payment Program which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs). This clearance is necessary to enable CMS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improve quality and reduce complexity and burden. The information collected from MIPS eligible clinicians, third-party intermediaries, Medicare beneficiaries, and any other audiences that would support CMS in improving MIPS or the Quality Payment Program will help ensure that all stakeholders have an effective and efficient experience. This feedback will help improve user experience, assess methods for simplifying participation including data submission, improve and enhance the utility of web-based tools, and increase the effectiveness of communication with stakeholders.

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Authorizing Statute(s): US Code: 42 USC 1395w-4(s) Name of Law: Merit Based Incentive Program
   PL: Pub.L. 114 - 10 101 Name of Law: MACRA
   PL: Pub.L. 114 - 255 4002(b)(1)(b) Name of Law: 21st Century Cures Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 44684	05/21/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 64466	08/07/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 16

table that charts list of burden

IC Title	Form No.	Form Name
Quality Payment Program User Panel Registration Form (CMS-10807)	CMS-10807	QPP User Panel Registration Form
2026 Resource Library Assistant User Feedback Survey (CMS-10969)	CMS-10969	2026 Resource Library Assistant User Feedback Survey
CMS Electronic Prescribing of Controlled Substances Intercept Survey Intercept Survey (CMS-10921)	CmS-10921	Electronic Prescribing of Controlled Substances Intercept Survey
MVP Adoption Survey (CMS-10933)	CMS-10933	MVP Adoption Survey
MVP Adoption Survey (CMS-10933Revised)	CMS-10933R	MVP Adoption Survey
Non-participating Small and Solo Practice Survey (CMS-10898)	CMS-10898	Non-participating Small and Solo Practices Survey
PY24 QPP Submissions Experience Survey (CMS-10850)	CMS-10850	QPP Submissions Experience Survey
PY25 QPP Annual Performance Feedback Survey (CMS-10860 Revision 2)	CMS-10860 Revision 2	PY25 QPP Feedback Survey Guide
PY25 QPP Submissions Experience Survey (CMS-10850) Revised	CMS-10850 Revised	QPP Submissions Experience Survey
QPP Participation and Performance Resource Page Intercept Survey (CMS-10925)	CMS-10925	QPP Participation and Performance Resource Page Intercept Survey
QPP Web Content Generic Intercept Survey (CMS-10917)	CMS-10917	QPP Web Content Generic Intercept Survey
QPP/MIPS Post Webinar Presentation Satisfaction Survey (CMS-10862)	CMS-10862	QPP/MIPS Post Webinar Presentation Satisfaction Survey
Quality Payment Program MVP Registration Feedback Survey (CMS-10899)	CMS-10899	QPP MVP Registration Survey
Quality Payment Program Annual Performance Feedback Survey (CMS-10860 revised)	CMS-10860	QPP Feedback Survey
Quality Payment Program Annual Performance Feedback Survey (CMS-10860)	CMS-10860	QPP Feedback Survey
Quality Payment Program User Panel Registration Form (CMS-10807 revised))	CMS-10807 revised	QPP User Panel Registration Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	630,300	630,300	0	0	0	0
Annual Time Burden (Hours)	57,950	57,950	0	0	0	0
Annual Cost Burden (Dollars)	5,328,024	5,328,024	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $3,850,758

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/12/2024

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