Information Collection

Information Collection In Early & Periodic Screening, Diagnosis & Treatmt. Prog. Reg. (berc-506-f), Sec. 441.56(a) (2)(i)-(iv), 56(d), 58(b), 60(a)(4)(5), & 61(a)

IC 113499 under ICR 198405-0938-010 · OMB 0938-0354.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0354 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION IN EARLY & PERIODIC SCREENING, DIAGNOSIS & TREATMT. PROG. REG. (BERC-506-F), SEC. 441.56(A) (2)(I)-(IV), 56(D), 58(B), 60(A)(4)(5), & 61(A)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	14,450	14,450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.