Appendix B3 State User Account Sheet

APPENDIX B3. STATE USER ACCOUNT SHEET

User ID and Password for EPICCS

State Data File Submission Website

OMB Number: 0584-XXXX

Expiration Date: XX/XX/XXXX

Login Information for <STATE>

Website: https://www.epiccs-statefile.org

User Name: <User Name>

Password: <PASSWORD>

• Please note that passwords are case sensitive.

For technical problems, please contact us at 855-272-0058 or [email protected]

For all other questions including those related to submission of data files, please contact your State technical assistance liaison:

<KOKOPELLI TEAM MEMBER>

<KOKOPELLI TEAM MEMBER TOLL FREE NUMBER>

<KOKOPELLI TEAM MEMBER EMAIL ADDRESS>

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 2 minutes per response, including the time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information.