Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 414.1335
42 CFR 414.1380
42 CFR 414.1440
42 CFR 414.1360
42 CFR 414.1430
42 CFR 414.1400
42 CFR 414.1325
42 CFR 414.1375
42 CFR 414.1445
42 CFR 414.1395
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Appendix A1
2024 MIPS QCDR and Registry Self-nomination User Guide
Appendix A1 2024 MIPS QCDR Registry Self-Nomination User Guide.pdf
Yes
Yes
Fillable Fileable
Form
Appendix B1
2024 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
Appendix B1 2024 Payer Initiated Submission Form.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix C1
2024 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
Appendix C1 2024 Eligible Clinician Initiated Submission Form.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix D1
2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
Appendix D1 2024 All-Payer QP Data Submission Form.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix E
Measures under Consideration 2023 Data Template for Candidate Measures
Appendix E 2023 MUC Data Template.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix F
2023 Peer Reviewed Journal Article Requirement Template
Appendix F 2023 MIPS Peer-Reviewed Journal Article Requirement Template.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix G1
Improvement Activities Performance Category, 2024 Call for Activities Submission Form
Appendix G1 2024 IA Call for Activities Submission Form.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix H1
2023 MIPS Promoting Interoperability Hardship Exception Application Guide
Appendix H1 2023 MIPS Promoting Interoperability Hardship Exception Application Guide.pptx
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix I1
2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide
Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide .pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix J1
2024 MVP Candidates: Instructions and Template
Appendix J1 2024 MVP Development Standardized Template.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix K1
2023 Partial QP Election Form
Appendix K1 Partial QP Submission Form.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix L
2023 MVP Registration Form
Appendix L MVP Registration Form.xlsx
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:
191,225
Number of Respondents for Small Entity:
0
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
191,225
1,365
0
30,332
0
159,528
Annual IC Time Burden (Hours)
728,142
-4,147
0
18,429
0
713,860
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Crosswalk: Appendix A1
Appendix A2 2024 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf
11/16/2023
Crosswalk: Appendix B1
Appendix B2 2024 Payer Initiated Submission Form Crosswalk.pdf
11/16/2023
Crosswalk: Appendix C1
Appendix C2 2024 Eligible Clinician Initiated Submission Form Crosswalk.pdf
11/16/2023
Crosswalk: Appendix D1
Appendix D2 2024 All-Payer QP Data Submission Form Crosswalk.pdf
11/16/2023
Crosswalk: Appendix G1
Appendix G2 2024 IA Call for Activities Crosswalk.pdf
11/16/2023
Crosswalk: Appendix H1
Appendix H2 2023 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf
11/16/2023
Crosswalk: Appendix I1
Appendix I2 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk .pdf
11/16/2023
Crosswalk: Appendix J1
Appendix J2 2024 MVP Submission Template Crosswalk.pdf
11/16/2023
Crosswalk: Appendix K1
Appendix K2 Partial QP Submission Form Crosswalk.pdf
11/16/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.