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OMB Control No: 0938-0354	ICR Reference No: 199807-0938-012
Status: Historical Active	Previous ICR Reference No: 199706-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Annual Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT) Participation Report -- 42 CFR 441.60
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/1998
	Date Received in OIRA: 07/22/1998
Terms of Clearance: This information collection is approved through 3-1999 under the following conditions: As indicated by HCFA in this submission, the Agency will submit the revised HCFA 416 within the next year. As agreed to by HCFA, the agency will 1) incorporate HEDIS measures in the design of the report; 2)coordinate the data in the form to support the inclusion of EPSDT outcome measures in the GPRA Strategic Plan and Annual Performance Plan; 3)incorporate the comments from the Dental community; 4) modify the format of the 416 to reflect state effectiveness in achieving healthy outcomes for children, to the extent allowed by law; and 5) reduce the reporting burden on States. If the HCFA information collection package HCFA submits within the next year does not include these terms, OMB will return it as improperly submitted. OMB also notes that this collection has been in violation of the Paperwork Reduction Act for over a year. HCFA shall submit the next package before the OMB clearance expires.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1999	03/31/1999	09/30/1998
Responses	56	0	56
Time Burden (Hours)	1,568	0	1,568
Cost Burden (Dollars)	15,000,000	0	15,000,000

Abstract: States are required to submit an annual report on the provision of EPSDT services to HCFA pursuant to section 1902(a)(43) of the Social Security Act. These reports provide HCFA with data necessary to assess the effectiveness of State EPSDT programs, to develop trend patterns and projections nationally, to determine a State's results in achieving its participation goal and to respond to inquiries. Respondents are State Medicaid agencies.

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Annual Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT) Participation Report -- 42 CFR 441.60	HCFA-416

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	56	56
Annual Time Burden (Hours)	1,568	1,568
Annual Cost Burden (Dollars)	15,000,000	15,000,000

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

View ICR - OIRA Conclusion