View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Quality Payment Program Annual Performance Feedback Survey (CMS-10860 revised)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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-10860	QPP Feedback Survey	2024 QPP Feedback Survey Instrument clean.docx		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: 750	Number of Respondents for Small Entity: 0

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

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	750	0	750	0	0	0
Annual IC Time Burden (Hours)	188	0	188	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10860 Supporting Statement	2024 QPP performance feedback Survey Supporting Statement.docx	05/29/2024
Tracked changed instrument	2024 QPP Feedback Survey Instrument track changes.docx	05/29/2024

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