Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report (CMS-416)

ICR 202305-0938-017

OMB: 0938-0354

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-416 Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report Form	Modified
CMS-416 - Supporting Statement A (2023 version 4).docx Supporting Statement A	2023-05-23
Response to Public Comments.docx Supplementary Document	2023-05-23

IC Document Collections

IC ID	Document Title	Status
7986	Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report Form	Modified