OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0938-0354 · HHS/CMS.

OMB 0938-0354

States are required to submit an annual report on the provision of EPSDT services to CMS pursuant to section 1902(a)(43)(D) of the Social Security Act. These reports provide CMS with data necessary to assess the effectiveness of State EPSDT programs, to determine a state's results in achieving its participation goal, and to respond to inquiries. Respondents are State Medicaid agencies. The data is due April 1 of every year so States need to have the form and instructions as soon as possible in order to report timely.

The latest form for Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report (CMS-416) expires 2029-06-30 and is listed under ICR 202604-0938-013.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-416 Annual EPSDT Participation ReportForm
CMS-416 - Supporting Statement A (2026 version 3).docxSupporting Statement A
Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report Form
Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202604-0938-013 Revision of a currently approved collection 2026-04-16
202305-0938-017 Extension without change of a currently approved collection 2023-05-24 Approved without change
202002-0938-015 Revision of a currently approved collection 2020-02-27 Approved without change
201702-0938-010 Revision of a currently approved collection 2017-02-24 Approved without change
201507-0938-009 No material or nonsubstantive change to a currently approved collection 2015-07-14 Approved without change
201312-0938-009 Revision of a currently approved collection 2013-12-10 Approved without change
201009-0938-018 Revision of a currently approved collection 2010-09-30 Approved with change
201003-0938-002 Extension without change of a currently approved collection 2010-03-24 Approved without change
200908-0938-014 Revision of a currently approved collection 2009-08-31 Approved without change
200903-0938-002 Revision of a currently approved collection 2009-03-10 Approved without change
200601-0938-011 Extension without change of a currently approved collection 2006-01-26 Approved without change
200209-0938-008 Extension without change of a currently approved collection 2002-09-26 Approved with change
199905-0938-009 Reinstatement with change of a previously approved collection 1999-05-27 Approved without change
199902-0938-004 Extension without change of a currently approved collection 1999-02-05 Withdrawn
199807-0938-012 Extension without change of a currently approved collection 1998-07-22 Approved without change
199706-0938-011 Extension without change of a currently approved collection 1997-06-25 Approved without change
199506-0938-003 Extension without change of a currently approved collection 1995-06-28 Approved without change
199305-0938-002 Revision of a currently approved collection 1993-05-13 Approved without change
199004-0938-002 Revision of a currently approved collection 1990-04-20 Approved without change
198707-0938-005 Revision of a currently approved collection 1987-07-28 Approved without change
198405-0938-010 New collection (Request for a new OMB Control Number) 1984-05-17 Approved without change