View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0354	ICR Reference No: 200903-0938-002
Status: Historical Active	Previous ICR Reference No: 200601-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report (CMS-416)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/28/2009
	Date Received in OIRA: 03/10/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2012	36 Months From Approved	04/30/2009
Responses	56	0	56
Time Burden (Hours)	1,568	0	1,568
Cost Burden (Dollars)	15,000	0	15,000

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