Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2021 > (Improvement Activities Performance Category) Data Submission (see SS-A Table 21) Removed 0 0 0
2021 > (Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 22) Removed 0 0 0 Form CMS-10621 Improvement Activities Performance Category, 2021 Call for Activities Submission Form
2021 > (PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 19) Removed 0 0 0 Form and Instruction CMS-10621 Promoting Interoperability Performance Category, 2021 Call for Measures Submission Form
2021 > (PI Performance Category) Data Submission (see SS-A Table 18) Removed 0 0 0
2021 > (PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 16) Removed 0 0 0 Form CMS-10621 Hardship Exception Application Form
Form CMS-10621 Extreme and Uncontrollable Circumstances Application Form
2021 > (Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 28) Removed 0 0 0
2021 > (Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13) Removed 0 0 0
2021 > (Quality Performance Category) Call for Quality Measures (see SS-A Table 15) Removed 0 0 0 Form and Instruction CMS-10621 Peer Reviewed Journal Article Requirement Template
Form and Instruction CMS-10621 Measures under Consideration 2019, Data Template for Candidate Measures
2021 > (Quality Performance Category) Claims Collection Type (see Table SS-A 10) Removed 0 0 0
2021 > (Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11) Removed 0 0 0
2021 > (Quality Performance Category) Registration and Enrollment for CMS Web Interface (see SS-A Table 14) Removed 0 0 0 Instruction
2021 > (Quality Performance Category) eCQM Collection Type (see SS-A Table 12) Removed 0 0 0
2021 > Nomination of MVPs (SS-A Table 23) Removed 0 0 0 Form and Instruction CMS-10621 Stakeholder Submissions of MIPS Value Pathways (MVP) Candidates: Instructions and Template
2021 > Open Authorization Credentialing and Token Request Process (SS-A Table 5) Removed 0 0 0
2021 > Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 26) Removed 0 0 0 Form CMS-10621 Eligible Clinician Initiated Submission Form
2021 > Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 25) Removed 0 0 0 Form and Instruction CMS-10621 Payer Initiated Submission Form
2021 > Partial Qualifying APM Participant (QP) Election (see SS-A Table 24) Removed 0 0 0
2021 > QPP Identity Management Application Process (see SS-A Table 9) Removed 0 0 0
2021 > Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4) Removed 0 0 0 Instruction
Instruction
Form CMS-10621 2021 Qualified Clinical Data Registry (QCDR) Measure Submission Template
2021 > Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 27) Removed 0 0 0 Form CMS-10621 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
2022 >> (Improvement Activities Performance Category) Data Submission (see SS-A Table 21) Removed 0 0 0
2022 >> (Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 22) Removed 0 0 0 Form CMS-10621 Improvement Activities Performance Category, 2021 Call for Activities Submission Form
2022 >> (PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 19) Removed 0 0 0 Form and Instruction CMS-10621 Promoting Interoperability Performance Category, 2021 Call for Measures Submission Form
2022 >> (PI Performance Category) Data Submission (see SS-A Table 18) Removed 0 0 0
2022 >> (PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 16) Removed 0 0 0 Form CMS-10621 Hardship Exception Application Form
Form CMS-10621 Extreme and Uncontrollable Circumstances Application Form
2022 >> (Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 28) Removed 0 0 0
2022 >> (Quality Performance Category) Call for Quality Measures (see SS-A Table 15) Removed 0 0 0 Form and Instruction CMS-10621 Peer Reviewed Journal Article Requirement Template
Form and Instruction CMS-10621 Measures under Consideration 2019, Data Template for Candidate Measures
2022 >> (Quality Performance Category) Claims Collection Type (see Table SS-A 10) Removed 0 0 0
2022 >> (Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11) Removed 0 0 0
2022 >> (Quality Performance Category) eCQM Collection Type (see SS-A Table 12) Removed 0 0 0
2022 >> Nomination of MVPs (SS-A Table 23) Removed 0 0 0 Form and Instruction CMS-10621 Stakeholder Submissions of MIPS Value Pathways (MVP) Candidates: Instructions and Template
2022 >> Open Authorization Credentialing and Token Request Process (SS-A Table 5) Removed 0 0 0
2022 >> Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 26) Removed 0 0 0 Form CMS-10621 Eligible Clinician Initiated Submission Form
2022 >> Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 25) Removed 0 0 0 Form and Instruction CMS-10621 Payer Initiated Submission Form
2022 >> Partial Qualifying APM Participant (QP) Election (see SS-A Table 24) Removed 0 0 0
2022 >> QPP Identity Management Application Process (see SS-A Table 9) Removed 0 0 0
2022 >> Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4) Removed 0 0 0 Instruction
Instruction
Form CMS-10621 2021 Qualified Clinical Data Registry (QCDR) Measure Submission Template
2022 >> Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 27) Removed 0 0 0 Form CMS-10621 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
CY 2022 Performance Period/2024 MIPS Payment Year Burden Summary New 310051 1435361 0 Other-Appendix A1 (See Table 3): 2022 Qualified Registry Fact Sheet (Revised)
Other-Appendix B1 (See Table 4): 2022 Qualified Clinical Data Registry (QCDR) Fact Sheet (Revised)
Form and Instruction CMS-10621 Appendix D1 (See Table 27): 2022 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) (Revised)
Form and Instruction CMS-10621 Appendix E1 (See Table 28): 2022 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submissi
Form and Instruction CMS-10621 Appendix F1 (See Table 29): 2022 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option (Revised)
Form and Instruction CMS-10621 Appendix G1 (See Table 15): Measures under Consideration 2021 (for the 2023 performance period), Data Template for Candidate Measures (Revised)
Form and Instruction CMS-10621 Appendix H1 (See Table 15): 2022 Peer Reviewed Journal Article Requirement Template (Revised)
Form and Instruction CMS-10621 Appendix I1 (See Table 20): Promoting Interoperability Performance Category, 2022 Call for Measures Submission Form (Revised)
Form and Instruction CMS-10621 Appendix J1 (See Table 24): Improvement Activities Performance Category, 2022 Call for Activities Submission Form (Revised)
Form and Instruction CMS-10621 Appendix M1 (See Table 25): 2022 MVP Candidates: Instructions and Template (Revised)
Form and Instruction CMS-10621 Appendix O1 (See Table 26): 2020 Partial QP Election Form (for the 2022 MIPS payment year) (New)
Form and Instruction cms-10621 Appendix C1 (Table 4): 2022 Qualified Clinical Data Registry (QCDR) Measure Submission Template (Revised, Conversion to Webform)
Form and Instruction cms-10621 Appendix K1 (See Table 16): 2021 Hardship Exception Application Form (for the 2023 MIPS payment year) (No change)
Form and Instruction cms-10621 Appendix L1 (See Table 16): 2021 Extreme and Uncontrollable Circumstances Application Form for the 2023 MIPS payment year (No change)
Form and Instruction CMS-10621 Appendix N1 (See Table 13): 2021 CMS Web Interface and CAHPS for MIPS Registration Guide (for the 2023 MIPS payment year) (Revised)
CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary New 322970 1390019 0
Total burden requested under this ICR: 633021 2825380 0  
To view an IC, click on IC Title