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Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-416 No No Fillable Printable
Instruction No No Paper Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   0 %

  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 56 0 0 0 0 56
Annual IC Time Burden (Hours) 1,568 0 0 0 0 1,568
Annual IC Cost Burden (Dollars) 15,000 0 0 0 0 15,000

Title Document Date Uploaded
Track Change Document of revised Instructions 02/25/2009
Crosswalk document for Changes 02/25/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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