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

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

OMB: 0938-0354

IC ID: 7986

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Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-416 Annual EPSDT Participation Report CMS416 final with PRA.xlsx Yes Yes Fillable Printable
Instruction CMS416InstructionsUpdated508.pdf No   Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  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 56 0 0 0 0 56
Annual IC Time Burden (Hours) 1,512 0 0 0 0 1,512
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change: Instructions CMS-416 Instructions Updated redline 022323.docx 05/23/2023
Crosswalk: Instructions 416InstructionsCrosswalk508-1.pdf 05/23/2023
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