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Early Periodic Screening Diagnostic And Treatment (epsdt) Report

IC 113368 under ICR 198707-0938-006 · OMB 0938-0291.

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Information Collection (IC) Details

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EARLY PERIODIC SCREENING DIAGNOSTIC AND TREATMENT (EPSDT) REPORT
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-420 No No


    

54 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 216 0 0 0 0 216
Annual IC Time Burden (Hours) 1,944 0 0 0 0 1,944
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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