Quality Payment Program User Panel Registration Form (CMS-10807)

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

Documents and Forms

Document Name Document Type
Form CMS-10807 Quality Payment Program User Panel Registration Form (CMS-10807) Form and Instruction
CMS-10807 QPP User Panel Registration Form CMS-10807 QPP User Panel Registration Form.docx Form and Instruction
CMS-10807 QPP User Panel Registration Form CMS-10807 QPP User Panel Registration Form.docx Form and Instruction
CMS-10807 QPP User Panel Registration Supporting Statement 5-20-22.docx CMS-10807 Supporting Statement IC Document
CMS-10807 QPP User Panel Registration Supporting Statement 5-20-22.docx CMS-10807 Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Quality Payment Program User Panel Registration Form (CMS-10807)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10807	QPP User Panel Registration Form	CMS-10807 QPP User Panel Registration Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	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 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	1,660	1,660
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10807 Supporting Statement	CMS-10807 QPP User Panel Registration Supporting Statement 5-20-22.docx	08/08/2024

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