Information Collection

CY 2025 Performance Period/2027 MIPS Payment Year

IC 271014 under ICR 202409-0938-018 · OMB 0938-1314.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1314 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Appendix A1 CY 2025 Performance Period/2027 MIPS Payment Year	Form and Instruction
Appendix A1 2025 MIPS QCDR and Registry Self-nomination User Guide Appendix A1 2025 MIPS QCDR Registry Self-Nomination User Guide.pdf	Form and Instruction
Appendix A1 2025 MIPS QCDR and Registry Self-nomination User Guide Appendix A1 2025 MIPS QCDR Registry Self-Nomination User Guide.pdf	Form and Instruction
Appendix B 2024 Submission Form for Other Payer Requests for Other Appendix B 2024 Payer Initiated Submission Form.pdf	Form and Instruction
Appendix B 2024 Submission Form for Other Payer Requests for Other Appendix B 2024 Payer Initiated Submission Form.pdf	Form and Instruction
Appendix C 2024 Submission Form for Eligible Clinician and APM Enti Appendix C 2024 Eligible Clinician Initiated Submission Form.pdf	Form and Instruction
Appendix C 2024 Submission Form for Eligible Clinician and APM Enti Appendix C 2024 Eligible Clinician Initiated Submission Form.pdf	Form and Instruction
Appendix D 2024 Submission Form for Requests for Qualifying Alterna Appendix D 2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the	Form and Instruction
Appendix D 2024 Submission Form for Requests for Qualifying Alterna Appendix D 2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the	Form and Instruction
Appendix E1 Measures under Consideration 2024 Data Template for Cand Appendix E1 Measures under Consideration 2024 Data Template for Candidate Measures.pdf	Form and Instruction
Appendix E1 Measures under Consideration 2024 Data Template for Cand Appendix E1 Measures under Consideration 2024 Data Template for Candidate Measures.pdf	Form and Instruction
Appendix F1 2024 Peer Reviewed Journal Article Requirement Template Appendix F1 2024 Peer Reviewed Journal Article Requirement Template.pdf	Form and Instruction
Appendix F1 2024 Peer Reviewed Journal Article Requirement Template Appendix F1 2024 Peer Reviewed Journal Article Requirement Template.pdf	Form and Instruction
Appendix G Improvement Activities Performance Category, 2024 Call f Appendix G Improvement Activities Performance Category 2024 Call for Activities Submission Form.pdf	Form and Instruction
Appendix G Improvement Activities Performance Category, 2024 Call f Appendix G Improvement Activities Performance Category 2024 Call for Activities Submission Form.pdf	Form and Instruction
Appendix H1 2024 MIPS Promoting Interoperability Hardship Exception Appendix H1 2024 MIPS Promoting Interoperability Hardship Exception Application Guide.pdf	Form and Instruction
Appendix H1 2024 MIPS Promoting Interoperability Hardship Exception Appendix H1 2024 MIPS Promoting Interoperability Hardship Exception Application Guide.pdf	Form and Instruction
Appendix I1 2024 MIPS Extreme and Uncontrollable Circumstances Excep Appendix I1 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide.pdf	Form and Instruction
Appendix I1 2024 MIPS Extreme and Uncontrollable Circumstances Excep Appendix I1 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide.pdf	Form and Instruction
Appendix J 2024 MVP Candidates: Instructions and Template Appendix J 2024 MVP Candidates Instructions and Template.pdf	Form and Instruction
Appendix J 2024 MVP Candidates: Instructions and Template Appendix J 2024 MVP Candidates Instructions and Template.pdf	Form and Instruction
Appendix K 2023 Partial QP Election Form (for submission in CY 2024 Appendix K 2023 Partial QP Election Form (for submission in CY 2024).pdf	Form and Instruction
Appendix K 2023 Partial QP Election Form (for submission in CY 2024 Appendix K 2023 Partial QP Election Form (for submission in CY 2024).pdf	Form and Instruction
Appendix L 2024 MVP Registration Form Appendix L 2024 MVP Registration Form.pdf	Form and Instruction
Appendix L 2024 MVP Registration Form Appendix L 2024 MVP Registration Form.pdf	Form and Instruction
Appendix A2 2025 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf Crosswalk - Appendix A2: 2025 MIPS QCDR and Registry Self-nomination User Guide	IC Document
Appendix A2 2025 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf Crosswalk - Appendix A2: 2025 MIPS QCDR and Registry Self-nomination User Guide	IC Document
Appendix E2 Measures under Consideration 2024 Data Template for Candidate Measures Crosswalk.pdf Crosswalk - Appendix E2: Measures under Consideration 2024 Data Template for Candidate Measures	IC Document
Appendix E2 Measures under Consideration 2024 Data Template for Candidate Measures Crosswalk.pdf Crosswalk - Appendix E2: Measures under Consideration 2024 Data Template for Candidate Measures	IC Document
Appendix F2 2024 Peer Reviewed Journal Article Requirement Template Crosswalk.pdf Crosswalk - Appendix F2: 2024 Peer Reviewed Journal Article Requirement Template	IC Document
Appendix F2 2024 Peer Reviewed Journal Article Requirement Template Crosswalk.pdf Crosswalk - Appendix F2: 2024 Peer Reviewed Journal Article Requirement Template	IC Document
Appendix H2 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf Crosswalk - Appendix H2: 2024 MIPS Promoting Interoperability Hardship Exception Application Guide	IC Document
Appendix H2 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf Crosswalk - Appendix H2: 2024 MIPS Promoting Interoperability Hardship Exception Application Guide	IC Document
Appendix I2 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk.pdf Crosswalk - Appendix I2: 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide	IC Document
Appendix I2 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk.pdf Crosswalk - Appendix I2: 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

CY 2025 Performance Period/2027 MIPS Payment Year

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendix A1	2025 MIPS QCDR and Registry Self-nomination User Guide	Appendix A1 2025 MIPS QCDR Registry Self-Nomination User Guide.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix B	2024 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)	Appendix B 2024 Payer Initiated Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix C	2024 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission	Appendix C 2024 Eligible Clinician Initiated Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix D	2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option	Appendix D 2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix E1	Measures under Consideration 2024 Data Template for Candidate Measures	Appendix E1 Measures under Consideration 2024 Data Template for Candidate Measures.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix F1	2024 Peer Reviewed Journal Article Requirement Template	Appendix F1 2024 Peer Reviewed Journal Article Requirement Template.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix G	Improvement Activities Performance Category, 2024 Call for Activities Submission Form	Appendix G Improvement Activities Performance Category 2024 Call for Activities Submission Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix H1	2024 MIPS Promoting Interoperability Hardship Exception Application Guide	Appendix H1 2024 MIPS Promoting Interoperability Hardship Exception Application Guide.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix I1	2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide	Appendix I1 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix J	2024 MVP Candidates: Instructions and Template	Appendix J 2024 MVP Candidates Instructions and Template.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix K	2023 Partial QP Election Form (for submission in CY 2024)	Appendix K 2023 Partial QP Election Form (for submission in CY 2024).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix L	2024 MVP Registration Form	Appendix L 2024 MVP Registration Form.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 136,053

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	136,053	136,053
Annual IC Time Burden (Hours)	649,776	649,776
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk - Appendix A2: 2025 MIPS QCDR and Registry Self-nomination User Guide	Appendix A2 2025 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf	09/17/2024
Crosswalk - Appendix E2: Measures under Consideration 2024 Data Template for Candidate Measures	Appendix E2 Measures under Consideration 2024 Data Template for Candidate Measures Crosswalk.pdf	09/17/2024
Crosswalk - Appendix F2: 2024 Peer Reviewed Journal Article Requirement Template	Appendix F2 2024 Peer Reviewed Journal Article Requirement Template Crosswalk.pdf	09/17/2024
Crosswalk - Appendix H2: 2024 MIPS Promoting Interoperability Hardship Exception Application Guide	Appendix H2 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf	09/17/2024
Crosswalk - Appendix I2: 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide	Appendix I2 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk.pdf	09/17/2024

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