OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 225029 under ICR 202502-0938-001 · OMB 0938-1152.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Connect: Direct Applications for RAPS, Encounter, PDE, and MMP
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL 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 512 Byte 20241206.docx Yes Yes Printable Only
Instruction MMP Connect Direct Form 512 Byte 20241206.docx Yes Yes Printable Only

Health Health Care Services

CMS Encounter Data System (EDS)  83 FR 6591

9 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 9 0 0 0 0 9
Annual IC Time Burden (Hours) 0 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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 LINED PDE Connect Direct Form 512 Byte 20241206.pdf 02/03/2025
Red Lined _ MMP Connect Direct Form RED LINED MMP Connect Direct Form 512 Byte 20241206.pdf 02/03/2025
MMP Crosswalk CMS-10340 MMP Crosswalk 12-9-2024.xlsx 02/03/2025
PDE Crosswalk CMS-10340 PDE Crosswalk 12-9-2024.xlsx 02/03/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.