?414.1330 and §414.1335 Claims Submission Mechanism

(CMS-10621) Merit-based Incentive Payment System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1314 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10621 ?414.1330 and §414.1335 Claims Submission Mechanism Form and Instruction
CMS-10621 List of Quality Performance Category Measures MIPS PRA Appendix A- List of Quality Performance Category Measures.docx Form and Instruction

Information Collection (IC) Details

IC Title:	§414.1330 and §414.1335 Claims Submission Mechanism	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.1330 and 414.1335

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10621	List of Quality Performance Category Measures	MIPS PRA Appendix A- List of Quality Performance Category Measures.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 299,169	Number of Respondents for Small Entity: 299,169

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	299,169	299,169
Annual IC Time Burden (Hours)	5,325,208	5,325,208
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.