Information Collection Request

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)

ICR 202401-0938-011 · OMB 0938-1222 · Received in OIRA

Forms and Documents

Document Name	Status
Form CMS-10450 CAHPS for MIPS Group Registration Form and Instruction	Modified
Form CMS-10450 CAHPS for MIPS Survey Vendor Application Form and Instruction	Modified
Form CMS-10450 CAHPS for MIPS Survey Beneficiary Participation Form	Modified
CMS-10450-Supporting-Statement-B-FINAL.docx Supporting Statement B	2024-02-13
CMS-10450-Supporting-Statement-A-2-13-24.docx Supporting Statement A	2024-02-13
Appendix G Technical References.docx Supplementary Document	2018-12-13

IC Document Collections

IC ID	Document Title	Status
227777	CAHPS for MIPS Group Registration Form and Instruction	Modified
227776	CAHPS for MIPS Survey Vendor Application Form and Instruction	Modified
206234	CAHPS for MIPS Survey Beneficiary Participation Form	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-1222
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202107-0938-012
Agency Tracking No	CCSQ
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31