View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0354	ICR Reference No: 201009-0938-018
Status: Historical Active	Previous ICR Reference No: 201003-0938-002
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 with change	Conclusion Date: 12/20/2010
	Date Received in OIRA: 09/30/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	36 Months From Approved	04/30/2013
Responses	56	0	56
Time Burden (Hours)	1,568	0	1,568
Cost Burden (Dollars)	15,000	0	15,000

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