View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4)
 
No Modified
 
Mandatory
 
42 CFR §414.1400  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Appendix A 2020 MIPS Registry Self-Nomination Fact Sheet.docx Yes Yes Fillable Fileable
Instruction Appendix C 2020 QCDR Self-Nomination Fact Sheet.docx Yes Yes Fillable Fileable
Form CMS-10621 2020 Qualified Clinical Data Registry (QCDR) Measure Submission Template Appendix E 2020 QCDR Measure Submission Template.xlsx Yes Yes Fillable Fileable

Health Health Care Services

Quality Payment Program (QPP), System No. 09–70– 0539  83 FR 6587

229 229
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 229 0 -121 0 0 350
Annual IC Time Burden (Hours) 1,067 0 -1,479 -304 0 2,850
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk: 2020 Qualified Registry Fact Sheet Appendix B Registry Self-Nomination Fact Sheet Crosswalk.docx 11/22/2019
Crosswalk: 2020 Qualified Clinical Data Registry (QCDR) Fact Sheet Appendix D QCDR Self-Nomination Fact Sheet Crosswalk.docx 11/22/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.