?414.1360 (cpia)

(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⚠️ Notice: This information collection may be referencing outdated material.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 ?414.1360 (CPIA) Form and Instruction
CMS-10621 Proposed CPIA Inventory MIPS PRA Appendix C- Proposed CPIA Inventory.docx Form and Instruction

Information Collection (IC) Details

IC Title:	§414.1360 (CPIA)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR §414.1360 (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	Proposed CPIA Inventory	MIPS PRA Appendix C- Proposed CPIA Inventory.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 676,325	Number of Respondents for Small Entity: 676,325

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	676,325	676,325
Annual IC Time Burden (Hours)	2,028,975	2,028,975
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.