Information Collection

Connect: Direct Applications for RAPS, Encounter, PDE, and MMP

IC 225029 under ICR 202104-0938-010 · OMB 0938-1152.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1152 can be found here:

Documents and Forms

Document Name Document Type
RAPS Connect Direct Form v7.pdf Instruction
Encounter Connect Direct Form v7-CT.pdf Instruction
PDE Connect Direct Form v 7.pdf Instruction
MMP Connect Direct Form v 7-CT.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Connect: Direct Applications for RAPS, Encounter, PDE, and MMP	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	RAPS Connect Direct Form v7.pdf	Yes	Yes	Printable Only
Instruction	Encounter Connect Direct Form v7-CT.pdf	Yes	Yes	Printable Only
Instruction	PDE Connect Direct Form v 7.pdf	Yes	Yes	Printable Only
Instruction	MMP Connect Direct Form v 7-CT.pdf	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: CMS Encounter Data System (EDS)	FR Citation: 83 FR 6591

Number of Respondents: 9	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9	-2,755	2,764
Annual IC Time Burden (Hours)	1	-319	320
Annual IC Cost Burden (Dollars)	0	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.