Information Collection

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

IC 277079 under ICR 202408-0938-002 · OMB 0938-1399.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10860 QPP Feedback Survey Quality Payment Program Annual Performance Feedback Survey (CMS-10860 revised)	Form and Instruction
CMS-10860 QPP Feedback Survey 2025 QPP Feedback Survey Instrument - Clean.docx	Form and Instruction
2025 QPP Feedback Survey Instrument.docx Redline Survey	IC Document
CMS-10860 (revised) 2025 QPP performance feedback Survey Supporting Statement.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-10860				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
Redline Survey		08/14/2025
Supporting Statement		08/14/2025

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

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