Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CY 2022 Performance Period/2024 MIPS Payment Year Burden Summary Removed 0 0 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 Modified 159528 713860 0 Form and Instruction Appendix A Self-Nomination User Guide for Qualified Clinical Data Registries (QCDRs) and Qualified Registries
Form Appendix B1 2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
Form and Instruction Appendix C1 2023 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
Form and Instruction Appendix D1 2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
Form and Instruction Appendix E1 Measures under Consideration 2022 (for the 2024 performance period), Data Template for Candidate Measures
Form and Instruction Appendix F1 2023 Peer Reviewed Journal Article Requirement Template
Form and Instruction Appendix G1 Promoting Interoperability Performance Category, 2023 Call for Measures Submission Form
Form and Instruction Appendix H1 Improvement Activities Performance Category, 2023 Call for Activities Submission Form
Form and Instruction Appendix I 2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023)
Form and Instruction Appendix J 2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY2023
Form and Instruction Appendix K1 2023 MVP Candidates: Instructions and Template
Form and Instruction Appendix L1 2022 Partial QP Election Form (for submission in CY 2023)
Total burden requested under this ICR: 159528 713860 0  
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