Notice and Consent to be Treated by a Nonparticipating Provider or Nonparticipating Emergency Facility, Retention of Certain Documents, and Notice to Plan or Issuer – Consumer Burden
Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in (CMS-10780)
OMB: 0938-1401
IC ID: 249148
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1401 can be found here: