Information Collection

PY25 QPP Submissions Experience Survey (CMS-10850) Revised

IC 279746 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 Revised QPP Submissions Experience Survey PY25 QPP Submissions Experience Survey (CMS-10850) Revised	Form and Instruction
CMS-10850 Revised QPP Submissions Experience Survey CMS-10850 PY25 Submissions Survey Supporting Statement.docx	Form and Instruction
CMS-10850 PY25 Submissions Survey Supporting Statement.docx CMS-10850 Revised Supporting Statement	IC Document
PY25 Submissions Experience Survey instrument track changes.docx Crosswalk	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-10850 Revised				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 Revised Supporting Statement		04/01/2026
Crosswalk		04/01/2026

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

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