Information Collection

CY 2025 Performance Period/2027 MIPS Payment Year

IC 271014 under ICR 202412-0938-008 · OMB 0938-1314.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form Appendix A
CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix A
2025 MIPS QCDR and Registry Self-nomination User Guide CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix B
2025 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix C
2025 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix D
2025 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix E
Measures under Consideration 2024 Data Template for Candidate Measures CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix F
2024 Peer Reviewed Journal Article Requirement Template CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix G
Improvement Activities Performance Category, 2025 Call for Activities Submission Form CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix H
2024 MIPS Promoting Interoperability Hardship Exception Application Guide CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix I
2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix J
2025 MVP Candidates: Instructions and Template CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix K
2024 Partial QP Election Form (for submission in CY 2025) CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Form Appendix L
2024 MVP Registration Form CY 2025 Performance Period/2027 MIPS Payment Year
Form and Instruction
Appendix A 2025 MIPS QCDR and Registry Self-nomination User Guide
Appendix A 2025 MIPS QCDR Registry Self-Nomination User Guide.pdf
Form and Instruction
Appendix A 2025 MIPS QCDR and Registry Self-nomination User Guide
Appendix A 2025 MIPS QCDR Registry Self-Nomination User Guide.pdf
Form and Instruction
Appendix B 2025 Submission Form for Other Payer Requests for Other
Appendix B 2025 Payer Initiated Submission Form.pdf
Form and Instruction
Appendix B 2025 Submission Form for Other Payer Requests for Other
Appendix B 2025 Payer Initiated Submission Form.pdf
Form and Instruction
Appendix C 2025 Submission Form for Eligible Clinician and APM Enti
Appendix C 2025 Eligible Clinician Initiated Submission Form.pdf
Form and Instruction
Appendix C 2025 Submission Form for Eligible Clinician and APM Enti
Appendix C 2025 Eligible Clinician Initiated Submission Form.pdf
Form and Instruction
Appendix D 2025 Submission Form for Requests for Qualifying Alterna
Appendix D 2025 Submission Form for Requests for QP Determinations - All-Payer Combination Option.pdf
Form and Instruction
Appendix D 2025 Submission Form for Requests for Qualifying Alterna
Appendix D 2025 Submission Form for Requests for QP Determinations - All-Payer Combination Option.pdf
Form and Instruction
Appendix E Measures under Consideration 2024 Data Template for Cand
Appendix E Measures under Consideration 2024 Data Template for Candidate Measures.pdf
Form and Instruction
Appendix E Measures under Consideration 2024 Data Template for Cand
Appendix E Measures under Consideration 2024 Data Template for Candidate Measures.pdf
Form and Instruction
Appendix F 2024 Peer Reviewed Journal Article Requirement Template
Appendix F1 2024 Peer Reviewed Journal Article Requirement Template.pdf
Form and Instruction
Appendix F 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, 2025 Call f
Appendix G Improvement Activities Performance Category 2025 Call for Activities Submission Form.pdf
Form and Instruction
Appendix G Improvement Activities Performance Category, 2025 Call f
Appendix G Improvement Activities Performance Category 2025 Call for Activities Submission Form.pdf
Form and Instruction
Appendix H 2024 MIPS Promoting Interoperability Hardship Exception
Appendix H 2024 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx
Form and Instruction
Appendix H 2024 MIPS Promoting Interoperability Hardship Exception
Appendix H 2024 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx
Form and Instruction
Appendix I 2024 MIPS Extreme and Uncontrollable Circumstances Excep
Appendix I 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide.pptx
Form and Instruction
Appendix I 2024 MIPS Extreme and Uncontrollable Circumstances Excep
Appendix I 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide.pptx
Form and Instruction
Appendix J 2025 MVP Candidates: Instructions and Template
Appendix J 2025 MVP Candidates Instructions and Template.pdf
Form and Instruction
Appendix J 2025 MVP Candidates: Instructions and Template
Appendix J 2025 MVP Candidates Instructions and Template.pdf
Form and Instruction
Appendix K 2024 Partial QP Election Form (for submission in CY 2025
Appendix K 2024 Partial QP Election Form (for submission in CY 2025).pdf
Form and Instruction
Appendix K 2024 Partial QP Election Form (for submission in CY 2025
Appendix K 2024 Partial QP Election Form (for submission in CY 2025).pdf
Form and Instruction
Appendix L 2024 MVP Registration Form
Appendix L 2024 MVP Registration Form.pptx
Form and Instruction
Appendix L 2024 MVP Registration Form
Appendix L 2024 MVP Registration Form.pptx
Form and Instruction
Appendix A2 2025 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf
CROSSWALK Appendix A: 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 A: 2025 MIPS QCDR and Registry Self-nomination User Guide
IC Document
Appendix B2 2025 Payer Initiated Submission Form Crosswalk.pdf
CROSSWALK Appendix B: 2025 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determina
IC Document
Appendix B2 2025 Payer Initiated Submission Form Crosswalk.pdf
CROSSWALK Appendix B: 2025 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determina
IC Document
Appendix C2 2025 Eligible Clinician Initiated Submission Form Crosswalk.pdf
CROSSWALK Appendix C : 2025 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative
IC Document
Appendix C2 2025 Eligible Clinician Initiated Submission Form Crosswalk.pdf
CROSSWALK Appendix C : 2025 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative
IC Document
Appendix D2 2025 All-Payer QP Data Submission Form Crosswalk.pdf
CROSSWALK Appendix D: 2025 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations
IC Document
Appendix D2 2025 All-Payer QP Data Submission Form Crosswalk.pdf
CROSSWALK Appendix D: 2025 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations
IC Document
Appendix E2 Measures under Consideration 2024 Data Template for Candidate Measures Crosswalk.pdf
CROSSWALK Appendix E: 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 E: Measures under Consideration 2024 Data Template for Candidate Measures
IC Document
Appendix F2 2024 Peer Reviewed Journal Article Requirement Template Crosswalk.pdf
CROSSWALK Appendix F: 2024 Peer Reviewed Journal Article Requirement Template
IC Document
Appendix F2 2024 Peer Reviewed Journal Article Requirement Template Crosswalk.pdf
CROSSWALK Appendix F: 2024 Peer Reviewed Journal Article Requirement Template
IC Document
Appendix G2 Improvement Activities Performance Category 2025 Call for Activities Submission Form Crosswalk.pdf
CROSSWALK Appendix G: Improvement Activities Performance Category, 2025 Call for Activities Submission Form
IC Document
Appendix G2 Improvement Activities Performance Category 2025 Call for Activities Submission Form Crosswalk.pdf
CROSSWALK Appendix G: Improvement Activities Performance Category, 2025 Call for Activities Submission Form
IC Document
Appendix H2 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf
CROSSWALK Appendix H: 2024 MIPS Promoting Interoperability Hardship Exception Application Guide
IC Document
Appendix H2 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf
CROSSWALK Appendix H: 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 I: 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 I: 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide
IC Document
Appendix J2 2025 MVP Candidates Instructions and Template Crosswalk.pdf
CROSSWALK Appendix J: 2025 MVP Candidates: Instructions and Template
IC Document
Appendix J2 2025 MVP Candidates Instructions and Template Crosswalk.pdf
CROSSWALK Appendix J: 2025 MVP Candidates: Instructions and Template
IC Document
Appendix K2 2025 Partial QP Submission Form Crosswalk.pdf
CROSSWALK Appendix K: 2024 Partial QP Election Form (for submission in CY 2025
IC Document
Appendix K2 2025 Partial QP Submission Form Crosswalk.pdf
CROSSWALK Appendix K: 2024 Partial QP Election Form (for submission in CY 2025
IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 Appendix A Yes Yes Fillable Fileable
Form and Instruction Appendix B Yes Yes Fillable Fileable
Form and Instruction Appendix C Yes Yes Fillable Fileable
Form and Instruction Appendix D Yes Yes Fillable Fileable
Form and Instruction Appendix E Yes Yes Fillable Fileable
Form and Instruction Appendix F Yes Yes Fillable Fileable
Form and Instruction Appendix G Yes Yes Fillable Fileable
Form and Instruction Appendix H Yes Yes Fillable Fileable
Form and Instruction Appendix I Yes Yes Fillable Fileable
Form and Instruction Appendix J Yes Yes Fillable Fileable
Form and Instruction Appendix K Yes Yes Fillable Fileable
Form and Instruction Appendix L Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 135,984 2,506 0 133,478 0 0
Annual IC Time Burden (Hours) 649,371 -7,570 0 656,941 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
CROSSWALK Appendix A: 2025 MIPS QCDR and Registry Self-nomination User Guide 12/11/2024
CROSSWALK Appendix B: 2025 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) 12/11/2024
CROSSWALK Appendix C : 2025 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submissio 12/11/2024
CROSSWALK Appendix D: 2025 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option 12/11/2024
CROSSWALK Appendix E: Measures under Consideration 2024 Data Template for Candidate Measures 12/11/2024
CROSSWALK Appendix F: 2024 Peer Reviewed Journal Article Requirement Template 12/11/2024
CROSSWALK Appendix G: Improvement Activities Performance Category, 2025 Call for Activities Submission Form 12/11/2024
CROSSWALK Appendix H: 2024 MIPS Promoting Interoperability Hardship Exception Application Guide 12/11/2024
CROSSWALK Appendix I: 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide 12/11/2024
CROSSWALK Appendix J: 2025 MVP Candidates: Instructions and Template 12/11/2024
CROSSWALK Appendix K: 2024 Partial QP Election Form (for submission in CY 2025 12/11/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].