View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	2021 > (Quality Performance Category) Registration and Enrollment for CMS Web Interface (see SS-A Table 14)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.1330 and 414.1335

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix N1 2020 CMS WI and CAHPS Registration Guide.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Quality Payment Program (QPP), System No. 09–70– 0539	FR Citation: 83 FR 6587

Number of Respondents: 90	Number of Respondents for Small Entity: 69

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 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	90	0	0	21	0	69
Annual IC Time Burden (Hours)	23	0	0	6	0	17
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk - 2021 CMS Web Interface and CAHPS for MIPS Registration	Appendix N2 2021 CMS Web Interface and CAHPS for MIPS Registration Guide Crosswalk.pdf	01/05/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.