Information Collection

PY24 QPP Submissions Experience Survey (CMS-10850)

IC 273179 under ICR 202408-0938-002 · OMB 0938-1399.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10850 QPP Submissions Experience Survey PY24 QPP Submissions Experience Survey (CMS-10850)	Form and Instruction
CMS-10850 QPP Submissions Experience Survey CMS-10850 PY24 Submissions Experience Survey instrument clean.docx	Form and Instruction
CMS-10850 PY24 Submissions Survey Supporting Statement.docx CMS-10850 Supporting Statement	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10850				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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10850 Supporting Statement		12/19/2024

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

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