Annual Early and Periodic Screening Diagnostic and Treatment Services (EPSDT) Participation Report -- CFR:441.60

ICR 199905-0938-009

OMB: 0938-0354

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0354 199905-0938-009
Historical Active 199902-0938-004
HHS/CMS
Annual Early and Periodic Screening Diagnostic and Treatment Services (EPSDT) Participation Report -- CFR:441.60
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 06/30/1999
Retrieve Notice of Action (NOA) 05/27/1999
  Inventory as of this Action Requested Previously Approved
06/30/2002 06/30/2002
56 0 0
1,568 0 0
15,000 0 0

States are required to submit an annual report on the provision of EPSDT services to HCFA pursuant to section 1902(A)(43) of the Social Security Act. These reports provide HCFA with data necessary to assess the effectiveness of State EPSDT programs, to develop trend patterns and projections nationally, to determine a State's results in achieving its participation goal, and to respond to inquiries. Respondents are State Medicaid agencies.

None
None


No

1
IC Title Form No. Form Name
Annual Early and Periodic Screening Diagnostic and Treatment Services (EPSDT) Participation Report -- CFR:441.60 HCFA-416

  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 56 0 0 56 0 0
Annual Time Burden (Hours) 1,568 0 0 1,568 0 0
Annual Cost Burden (Dollars) 15,000 0 0 15,000 0 0
Yes
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.
05/27/1999


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