Information Collection

Attachment J: CDS Connect – Participant

IC 242369 under ICR 202006-0935-003 · OMB 0935-0256.

Documents and Forms

Document Name Document Type
Form 7 Attachment J: CDS Connect – Participant Form and Instruction
7 Attachment J: CDS Connect – Participant Attachment J - CDS Connect – Participant.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment J: CDS Connect â Participant	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7	Attachment J: CDS Connect â Participant	Attachment J - CDS Connect â Participant.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
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.