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View Information Collection (IC)

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
Instruction Yes No Printable Only
Form CMS-416 Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   75 %

  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
CMS-416 Instructions 8-23-10 tracked 09/15/2010
Crosswalk CHIPRA PRA 09/15/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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