?414.1390 (Data Validation and Auditing)

(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⚠️ Notice: This information collection may be referencing outdated material.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 ?414.1390 (Data Validation and Auditing) Form and Instruction
CMS-10621 MIPS Data Validation Survey Respondent Communication MIPS PRA Appendix F- MIPS Data Validation Survey Respondent Communication.docx Form and Instruction
CMS-10621 MIPS Data Validation Electronic Survey MIPS PRA Appendix E- Sample MIPS Data Validation Electronic Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	§414.1390 (Data Validation and Auditing)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR §414.1390 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	MIPS Data Validation Survey Respondent Communication	MIPS PRA Appendix F- MIPS Data Validation Survey Respondent Communication.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10621	MIPS Data Validation Electronic Survey	MIPS PRA Appendix E- Sample MIPS Data Validation Electronic Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 430	Number of Respondents for Small Entity: 430

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	430	430
Annual IC Time Burden (Hours)	645	645
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.