Information Collection Request
Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report (CMS-416)
ICR 202305-0938-017 · OMB 0938-0354 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0354 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-416 Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report |
Form | Modified | Repair queued |
 CMS-416 - Supporting Statement A (2023 version 4).docx |
Supporting Statement A | Uploaded 2023-05-23 | Repair queued |
| Response to Public Comments.docx |
Supplementary Document | Uploaded 2023-05-23 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 7986 |  Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0354 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202002-0938-015 |
| Agency Tracking No | CMCS |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |