OMB control number

Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections (CMS-10695)

OMB 0938-1399 · HHS/CMS.

OMB 0938-1399

This generic clearance is for a program of survey and feedback collections supporting the Quality Payment Program which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs). This clearance is necessary to enable CMS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improve quality and reduce complexity and burden. The information collected from MIPS eligible clinicians, third-party intermediaries, Medicare beneficiaries, and any other audiences that would support CMS in improving MIPS or the Quality Payment Program will help ensure that all stakeholders have an effective and efficient experience. This feedback will help improve user experience, assess methods for simplifying participation including data submission, improve and enhance the utility of web-based tools, and increase the effectiveness of communication with stakeholders.

The latest form for Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections (CMS-10695) expires 2027-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10899 Quality Payment Program MVP Registration Feedback Survey (CMS-10899) Form and Instruction
Form CMS-10898 Non-participating Small and Solo Practice Survey (CMS-10898) Form and Instruction
Form CMS-10862 QPP/MIPS Post Webinar Presentation Satisfaction Survey (CMS-10862) Form and Instruction
Form CMS-10860 Quality Payment Program Annual Performance Feedback Survey (CMS-10860) Form and Instruction
Form CMS-10807 Quality Payment Program User Panel Registration Form (CMS-10807) Form and Instruction
CMS-10695 MIPS Survey Supporting Statement A_8-8-24.docx Supporting Statement A
CMS-10695 Supporting Statement Part B Research.docx Supporting Statement B
Quality Payment Program MVP Registration Feedback Survey (CMS-10899) Form and Instruction
Non-participating Small and Solo Practice Survey (CMS-10898) Form and Instruction
QPP/MIPS Post Webinar Presentation Satisfaction Survey (CMS-10862) Form and Instruction
Quality Payment Program Annual Performance Feedback Survey (CMS-10860) Form and Instruction
Quality Payment Program User Panel Registration Form (CMS-10807) Form and Instruction

All Historical Document Collections

202408-0938-002	Revision of a currently approved collection	2024-08-12
202006-0938-020 Approved with change	New collection (Request for a new OMB Control Number)	2020-07-01

OMB Details

Quality Payment Program User Panel Registration Form (CMS-10807)

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10807

QPP User Panel Registration Form

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.