View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	CY 2022 Performance Period/2024 MIPS Payment Year Burden Summary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Other-Appendix A1 (See Table 3): 2022 Qualified Registry Fact Sheet (Revised)					Yes	No	Printable Only
Other-Appendix B1 (See Table 4): 2022 Qualified Clinical Data Registry (QCDR) Fact Sheet (Revised)					Yes	No	Printable Only
Form and Instruction	CMS-10621				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10621				Yes	Yes	Fillable Fileable
Form and Instruction	cms-10621				Yes	Yes	Fillable Fileable
Form and Instruction	cms-10621				Yes	Yes	Fillable Fileable
Form and Instruction	cms-10621				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10621				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: 119,890	Number of Respondents for Small Entity: 119,890

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	0	0	0	-310,051	0	310,051
Annual IC Time Burden (Hours)	0	0	0	-1,435,361	0	1,435,361
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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