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OMB Control No: 0938-1222	ICR Reference No: 202607-0938-006
Status: Received in OIRA	Previous ICR Reference No: 202401-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 07/17/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	26,976	25,776
Time Burden (Hours)	6,139	5,867
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	26,976	25,776	1,200
Annual Time Burden (Hours)	6,139	5,867	272
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden for Vendor Completion of CAHPS for MIPS Participation Form Implementation of web administration is estimated to increase the time to complete the vendor participation form from 10 hours to 11 hours. We assume that 10 vendors will apply for CMS approval based on historic applications; 10 vendors x 11 hours = 110 hours, which is an increase of +10 hours to the 100 hours currently approved under OMB control number 0938-1222. Burden for Beneficiary Responses to the CAHPS for MIPS Survey Implementation of web administration is estimated to increase the number of beneficiaries responding per group from 255 to 267. Assuming 100 groups that have registered and have a sufficient beneficiary sample size to conduct the CAHPS for MIPS survey the survey will be administered to 26,700 beneficiaries per year; 26,700 beneficiaries x .2183 hours = 5,829, which is an increase of +262 hours to the 5,567 hours current approved under OMB control number 0938-1222.

Annual Cost to Federal Government: $1,346,456

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

Agency Contact: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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