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

View Information Collection (IC)

CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary
 
No Modified
 
Mandatory
 
42 CFR 414.1375 42 CFR 414.1445 42 CFR 414.1395 42 CFR 414.1335 42 CFR 414.1380 42 CFR 414.1360 42 CFR 414.1400 42 CFR 414.1430 42 CFR 414.1325 42 CFR 414.1440

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Appendix A 2023 QCDR and Registry Self-nomination User Guide Appendix A 2023 QCDR and Registry Self-Nomination User Guide_508.pdf Yes Yes Fillable Fileable
Form Appendix B Payer Initiated Submission Form Appendix B 2022 Payer Initiated Submission Form.pdf Yes Yes Fillable Fileable
Form Appendix C Eligible Clinician Initiated Submission Form Appendix C 2022 Clinician Initiated Submission Form.pdf Yes Yes Fillable Fileable
Form Appendix D Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Appendix D 2022 All-Payer QP Data Submission Form.pdf Yes Yes Fillable Fileable
Form Appendix E Data Template for Candidate Measures Appendix E 2021 MUC Data Template.pdf Yes Yes Fillable Fileable
Form Appendix F 2022 Peer Reviewed Journal Article Requirement Template Appendix F 2022 MIPS Peer Reviewed Template .pdf Yes Yes Fillable Fileable
Form Appendix G Promoting Interoperability Performance Category, 2022 Call for Measures Submission Form Appendix G 2022 PI Call for Measures Submission Form.pdf Yes Yes Fillable Fileable
Form Appendix H Improvement Activities Performance Category, 2022 Call for Activities Submission Form Appendix H 2022 IA Call for Activities Submission Form.pdf Yes Yes Fillable Fileable
Form Appendix I 2021 Hardship Exception Application Form Appendix I 2021 Promoting Operability Hardship Exception Application.pdf Yes Yes Fillable Fileable
Form Appendix J 2021 Extreme and Uncontrollable Circumstances Application Form Appendix J 2020 Extreme and Uncontrollable Circumstances Reweighting Application.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix K 2022 MVP Candidates: Instructions and Template Appendix K 2022 MVP Development Standardized Template.pdf Yes Yes Fillable Fileable
Form Appendix L 2020 Partial QP Election Form Appendix L Partial QP Submission Form.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

180,365 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 344,023 2,034 0 19,019 0 322,970
Annual IC Time Burden (Hours) 1,469,234 -11,039 0 90,254 0 1,390,019
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.