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

Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, MMPs, and PACE Organizations (CMS-10340)

Documents and Forms

Document Name Document Type
RAPS Connect Direct Form v7.pdf Instruction
RAPS Connect Direct Form v7.pdf Instruction
07172023 Enc Connect Direct Form.pdf Instruction
07172023 Enc Connect Direct Form.pdf Instruction
03242022 PDE Connect Direct Form.pdf Instruction
PDE Connect Direct Form_20240610 (1).docx Instruction
03242022 MMP Connect Direct Form.pdf Instruction
06142024 MMP Connect Direct Form.docx Instruction
07172023 Enc Connect Direct Form redlined.pdf Enc Connect Direct Form Redline IC Document
07172023 Enc Connect Direct Form redlined.pdf Enc Connect Direct Form Redline IC Document
RED LINE_PDE Connect Direct Form_20240610.docx Redline_PDE Connect Direct Form IC Document
Red Lined 06142024 MMP Connect Direct Form.docx Red Lined _ MMP Connect Direct Form IC Document

Information Collection (IC) Details

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	07172023 Enc Connect Direct Form.pdf	Yes	Yes	Printable Only
Instruction	PDE Connect Direct Form_20240610 (1).docx	Yes	Yes	Printable Only
Instruction	06142024 MMP Connect Direct Form.docx	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9	0	9
Annual IC Time Burden (Hours)	0	-1	1
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Enc Connect Direct Form Redline	07172023 Enc Connect Direct Form redlined.pdf	03/14/2024
Redline_PDE Connect Direct Form	RED LINE_PDE Connect Direct Form_20240610.docx	06/27/2024
Red Lined _ MMP Connect Direct Form	Red Lined 06142024 MMP Connect Direct Form.docx	06/27/2024

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