Quality Payment Program Annual Performance Feedback Survey (CMS-10860)

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

Documents and Forms

Document Name Document Type
Form CMS-10860 Quality Payment Program Annual Performance Feedback Survey (CMS-10860) Form and Instruction
CMS-10860 QPP Feedback Survey 2024 QPP Feedback Survey Instrument clean.docx Form and Instruction
CMS-10860 QPP Feedback Survey 2024 QPP Feedback Survey Instrument clean.docx Form and Instruction
2024 QPP performance feedback Survey Supporting Statement.docx CMS Supporting Statement IC Document
2024 QPP performance feedback Survey Supporting Statement.docx CMS Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Quality Payment Program Annual Performance Feedback Survey (CMS-10860)	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-10860	QPP Feedback Survey	2024 QPP Feedback Survey Instrument clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750	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	750	750
Annual IC Time Burden (Hours)	188	188
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS Supporting Statement	2024 QPP performance feedback Survey Supporting Statement.docx	08/09/2024

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