Information Collection

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

IC 225029 under ICR 202302-0938-015 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
RAPS Connect Direct Form v7.pdf	Instruction
RAPS Connect Direct Form v7.pdf	Instruction
Encounter Connect Direct Form v7-CT.pdf	Instruction
Encounter Connect Direct Form v7-CT.pdf	Instruction
03242022 PDE Connect Direct Form.pdf	Instruction
03242022 PDE Connect Direct Form.pdf	Instruction
03242022 MMP Connect Direct Form.pdf	Instruction
03242022 MMP Connect Direct Form.pdf	Instruction
01242023 MMP Connect Direct Form - Red Lined.docx MMP Connect Direct Form - Red Lined	IC Document
01242023 MMP Connect Direct Form - Red Lined.docx MMP Connect Direct Form - Red Lined	IC Document
01242023 PDE Connect Direct Form - Red Lined.docx PDE Connect Direct Form - Red Lined	IC Document
01242023 PDE Connect Direct Form - Red Lined.docx PDE Connect Direct Form - Red Lined	IC Document

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:

table that charts list of 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	03242022 PDE Connect Direct Form.pdf	Yes	Yes	Printable Only
Instruction	03242022 MMP Connect Direct Form.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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	9	9
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MMP Connect Direct Form - Red Lined	01242023 MMP Connect Direct Form - Red Lined.docx	02/22/2023
PDE Connect Direct Form - Red Lined	01242023 PDE Connect Direct Form - Red Lined.docx	02/22/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.