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 19) Modified 102474 8539 0
(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 20) Modified 31 93 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 17) Modified 10 5 0 Form and Instruction CMS-10621 Promoting Interoperability Performance Category: Call for Measures Submission Form
(PI Performance Category) Data Submission (see SS-A Table 16) Modified 77499 206664 0
(PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 14) Modified 52099 13025 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 26) Modified 9904 2476 0
(Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13) Removed 0 0 0
(Quality Performance Category) Call for Quality Measures (see SS-A Table 13) Modified 28 154 0 Form and Instruction CMS-10621 Data Template for Candidate Measures
Form and Instruction CMS-10621 Measures under Consideration 2019, Data Template for Candidate Measures
(Quality Performance Category) Claims Collection Type (see SS-A Table 10) Modified 94587 1343135 0
(Quality Performance Category) Group Registration for CMS Web Interface (see SS-A Table 14) Removed 0 0 0 Instruction
(Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11) Modified 115907 1052783 0
(Quality Performance Category) eCQM Collection Type (see SS-A Table 12) Modified 45951 367608 0
Nomination of MVPs (SS-A Table 21) New 25 300 0 Form and Instruction CMS-10621 MVP Candidates: Instructions and Template
Open Authorization Credentialing and Token Request Process (SS-A Table 5) New 15 15 0
Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 24) 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 23) Modified 80 800 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 22) Modified 300 75 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 239 1097 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 25) 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: 503591 3004765 0  
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