No Surprises Act: IDR Process

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249371	Request of Extension of Time Periods for Extenuating Circumstances		New
248857	IDR Entity Certification and IDR Entity Monthly Reporting		New
248850	Federal IDR Process for Air Ambulance Services		New
248846	Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities		New

ICR Details

OMB Control No: 1210-0169	ICR Reference No: 202108-1210-008
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: No Surprises Act: IDR Process
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  Yes
Type of Review Request: Emergency	Approval Requested By: 10/04/2021
OIRA Conclusion Action: Preapproved	Conclusion Date: 10/07/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/01/2021
Terms of Clearance: Approved consistent with the understanding that the agency will review and consider all comments received from the rule in addition to those received during the 60 and 30 FRN periods as this package transitions from an emergency to a standard collection

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2022	6 Months From Approved
Responses	18,338	0	0
Time Burden (Hours)	32,974	0	0
Cost Burden (Dollars)	99,300	0	0

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Abstract: Before January 1, 2022, the Department needs to certify the IDR entities, so the IDR process is available on January 1, 2022 and the regulated community needs to prepare for the January 1, 2022 applicability date. If normal clearance procedures are followed, this statutory deadline may be missed and the IDR process and other regulatory provisions will not be available with its accompany protections.

Emergency Justfication: Before January 1, 2022, the Department needs to certify the IDR entities, so the IDR process is available on January 1, 2022 and the regulated community needs to prepare for the January 1, 2022 applicability date. If normal clearance procedures are followed, this statutory deadline may be missed and the IDR process and other regulatory provisions will not be available with its accompany protections.

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Authorizing Statute(s): PL: Pub.L. 116 - 260 103 and 105 Name of Law: Consolidated Appropriations Act, 2021
  

Citations for New Statutory Requirements: PL: Pub.L. 105 - 105 No Surprises Act Name of Law: Consolidated Appropriations Act, 2021

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AC00	Final or interim final rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Federal IDR Process for Air Ambulance Services
Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities
IDR Entity Certification and IDR Entity Monthly Reporting
Request of Extension of Time Periods for Extenuating Circumstances

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	18,338	0	18,338	0	0	0
Annual Time Burden (Hours)	32,974	0	32,974	0	0	0
Annual Cost Burden (Dollars)	99,300	0	99,300	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $2,666,667

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  Yes

Description/Changes for Common Form Usage:  The Departments of Health and Human Services (HHS) and Treasury will be using the common forms, as well as the Office of Personnel Management (OPM) as the agencies share jurisdiction over provisions of the No Surprises Act.

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/01/2021

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