Information Collection

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

IC 275353 under ICR 202408-0938-002 · OMB 0938-1399.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10807 revised QPP User Panel Registration Form Quality Payment Program User Panel Registration Form (CMS-10807 revised))	Form and Instruction
CMS-10807 revised QPP User Panel Registration Form QPP User Panel Registration Form - Survey Instrument March 2025 Changes Doc - Cleaned.docx	Form and Instruction
CMS-10807 QPP User Panel Registration Supporting Statement - Update March 2025 (3).docx Supporting Statement	IC Document

IC Title:

Agency IC Tracking Number:

CCSQ

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-10807 revised				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement		05/20/2025

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

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