View Information Collection (IC)
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CY 2025 Performance Period/2027 MIPS Payment Year
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Appendix A1 2025 MIPS QCDR and Registry Self-nomination User Guide Appendix A1 2025 MIPS QCDR Registry Self-Nomination User Guide.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix B 2024 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) Appendix B 2024 Payer Initiated Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix C 2024 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Appendix C 2024 Eligible Clinician Initiated Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix D 2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Appendix D 2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix E1 Measures under Consideration 2024 Data Template for Candidate Measures Appendix E1 Measures under Consideration 2024 Data Template for Candidate Measures.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix F1 2024 Peer Reviewed Journal Article Requirement Template Appendix F1 2024 Peer Reviewed Journal Article Requirement Template.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix G Improvement Activities Performance Category, 2024 Call for Activities Submission Form Appendix G Improvement Activities Performance Category 2024 Call for Activities Submission Form.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix H1 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Appendix H1 2024 MIPS Promoting Interoperability Hardship Exception Application Guide.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix I1 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Appendix I1 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix J 2024 MVP Candidates: Instructions and Template Appendix J 2024 MVP Candidates Instructions and Template.pdf Yes Yes Fillable Fileable
Form and Instruction Appendix K 2023 Partial QP Election Form (for submission in CY 2024) Appendix K 2023 Partial QP Election Form (for submission in CY 2024).pdf Yes Yes Fillable Fileable
Form and Instruction Appendix L 2024 MVP Registration Form Appendix L 2024 MVP Registration Form.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

136,053 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 136,053 0 136,053 0 0 0
Annual IC Time Burden (Hours) 649,776 0 649,776 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk - Appendix A2: 2025 MIPS QCDR and Registry Self-nomination User Guide Appendix A2 2025 MIPS QCDR and Registry Self-Nomination User Guide Crosswalk.pdf 09/17/2024
Crosswalk - Appendix E2: Measures under Consideration 2024 Data Template for Candidate Measures Appendix E2 Measures under Consideration 2024 Data Template for Candidate Measures Crosswalk.pdf 09/17/2024
Crosswalk - Appendix F2: 2024 Peer Reviewed Journal Article Requirement Template Appendix F2 2024 Peer Reviewed Journal Article Requirement Template Crosswalk.pdf 09/17/2024
Crosswalk - Appendix H2: 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Appendix H2 2024 MIPS Promoting Interoperability Hardship Exception Application Guide Crosswalk.pdf 09/17/2024
Crosswalk - Appendix I2: 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Appendix I2 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide Crosswalk.pdf 09/17/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.