Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(Improvement Activities Performance Category) Data Submission (see SS-A Table 21) Modified 118515 9876 0
(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 22) Modified 128 256 0 Form CMS-10621 Improvement Activities Performance Category: Call for Activities Submission Form
(PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 19) Modified 28 14 0 Form and Instruction CMS-10621 Promoting Interoperability Performance Category: Call for Measures Submission Form
(PI Performance Category) Data Submission (see SS-A Table 18) Modified 93863 250301 0
(PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 16) Modified 6025 1506 0 Form CMS-10621 Hardship Exception Application Form
Form CMS-10621 Extreme and Uncontrollable Circumstances Application Form
(Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 27) Modified 11516 2879 0
(Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13) Modified 104 6414 0
(Quality Performance Category) Call for Quality Measures (see SS-A Table 15) Modified 26 143 0 Form and Instruction CMS-10621 Data Template for Candidate Measures
Instruction
(Quality Performance Category) Claims Collection Type (see Table SS-A 10) Modified 109951 1561304 0
(Quality Performance Category) Group Registration for CMS Web Interface (see SS-A Table 14) Modified 51 13 0 Instruction
(Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11) Modified 116591 1058996 0
(Quality Performance Category) eCQM Collection Type (see SS-A Table 12) Modified 51787 414296 0
Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 25) Modified 150 1500 0 Form CMS-10621 Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 24) Modified 110 1100 0 Form and Instruction CMS-10621 Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
Partial Qualifying APM Participant (QP) Election (see SS-A Table 23) Modified 2022 506 0
QPP Identity Management Application Process (see SS-A Table 9) Unchanged 3741 3741 0
Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4) Modified 381 3782 0 Instruction
Instruction
Form CMS-10621 2020 Qualified Clinical Data Registry (QCDR) Measure Submission Template
Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 26) Modified 551 2755 0 Form CMS-10621 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
Total burden requested under this ICR: 515540 3319382 0  
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