View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	2022 >> Quality Data Submission via the CMS Web Interface (SS-A Table 16)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10621	2021 CMS Web Interface and CAHPS for MIPS Registration Guide	Appendix N1 2022 CMS Web Interface and CAHPS for MIPS 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:	FR Citation:

Number of Respondents: 114	Number of Respondents for Small Entity: 114

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	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	114	0	114	0	0	0
Annual IC Time Burden (Hours)	7,030	0	7,030	0	0	0
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 Guide	Appendix N2 2022 CMS Web Interface and CAHPS for MIPS Registration Guide Crosswalk.pdf	09/01/2021

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