Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Removed 0 0 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)
CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary New 184564 715450 0 Form and Instruction Appendix A 2023 QCDR and Registry Self-nomination User Guide
Form Appendix L 2023 MVP Registration Form (New)
Form and Instruction Appendix I 2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY 2023) (previously Appendix J)
Form and Instruction Appendix B 2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
Form and Instruction Appendix C 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 D 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 2023 Data Template for Candidate Measures
Form and Instruction Appendix F1 2023 Peer Reviewed Journal Article Requirement Template
Form and Instruction Appendix J 2023 MVP Candidates: Instructions and Template (previously Appendix K)
Form and Instruction Appendix K 2022 Partial QP Election Form (for submission in CY 2023) (previously Appendix L)
Form and Instruction Appendix G Improvement Activities Performance Category, 2023 Call for Activities Submission Form (previously Appendix H)
Form and Instruction Appendix H 2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) (previously Appendix I)
Total burden requested under this ICR: 184564 715450 0  
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