Information Collection

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

IC 225029 under ICR 202606-0938-007 · OMB 0938-1152.

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 (clean)_508.pdf	Instruction
Encounter Connect Direct Form (clean)_508.pdf	Instruction
PDE Connect Direct Form 512 Byte 20241206.docx	Instruction
PDE Connect Direct Form 512 Byte 20241206.docx	Instruction
MMP Connect Direct Form 512 Byte 20241206.docx	Instruction
MMP Connect Direct Form 512 Byte 20241206.docx	Instruction
Encounter Connect Direct Form (redline) (1).docx Enc Connect Direct Form Redline	IC Document
Encounter Connect Direct Form (redline) (1).docx Enc Connect Direct Form Redline	IC Document
RED LINED PDE Connect Direct Form 512 Byte 20241206.pdf Redline_PDE Connect Direct Form	IC Document
RED LINED PDE Connect Direct Form 512 Byte 20241206.pdf Redline_PDE Connect Direct Form	IC Document
RED LINED MMP Connect Direct Form 512 Byte 20241206.pdf Red Lined _ MMP Connect Direct Form	IC Document
RED LINED MMP Connect Direct Form 512 Byte 20241206.pdf Red Lined _ MMP Connect Direct Form	IC Document
CMS-10340 MMP Crosswalk 12-9-2024.xlsx MMP Crosswalk	IC Document
CMS-10340 MMP Crosswalk 12-9-2024.xlsx MMP Crosswalk	IC Document
CMS-10340 PDE Crosswalk 12-9-2024.xlsx PDE Crosswalk	IC Document
CMS-10340 PDE Crosswalk 12-9-2024.xlsx PDE Crosswalk	IC Document

IC Title:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Yes	Yes	Printable Only
Instruction	Yes	Yes	Printable Only
Instruction	Yes	Yes	Printable Only
Instruction	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)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Enc Connect Direct Form Redline		06/09/2026
Redline_PDE Connect Direct Form		02/03/2025
Red Lined _ MMP Connect Direct Form		02/03/2025
MMP Crosswalk		02/03/2025
PDE Crosswalk		02/03/2025

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

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