EARLY PERIODIC SCREENING DIAGNOSTIC AND TREATMENT (EPSDT) REPORT

ICR 198507-0938-007

OMB: 0938-0291

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0291 198507-0938-007
Historical Active 198408-0938-023
HHS/CMS
EARLY PERIODIC SCREENING DIAGNOSTIC AND TREATMENT (EPSDT) REPORT
Revision of a currently approved collection   No
Regular
Approved without change 09/10/1985
Retrieve Notice of Action (NOA) 07/17/1985
  Inventory as of this Action Requested Previously Approved
09/30/1987 09/30/1987 09/30/1985
216 0 216
1,944 0 3,154
0 0 0

CONGRESS AND HCFA ARE INTERESTED IN THE EPSDT PROGRAM'S EFFECTIVENESS IN IMPROVING THE HEALTH OF MEDICAID ELIGIBLE CHILDREN. THE HCFA-420, SUBMITTED BY ALL 55 MEDICAID JURISDICTIONS, SUPPLIES DATA FOR PROMPT, ACCURATE MONITORING OF EPSDT ACTIVITY. AS WELL AS DATA NECESSARY FOR RESPONDING TO CONGRESSIONAL AND PUBLIC INQUIRIES.

None
None


No

1
IC Title Form No. Form Name
EARLY PERIODIC SCREENING DIAGNOSTIC AND TREATMENT (EPSDT) REPORT HCFA-420

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 216 216 0 0 0 0
Annual Time Burden (Hours) 1,944 3,154 0 0 -1,210 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/17/1985


© 2024 OMB.report | Privacy Policy