Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in

ICR 202205-1210-001CF

OMB: 0938-1401

Federal Form Document

ICR Details
0938-1401 202205-1210-001CF
Active 202109-1210-001CF
DOL/EBSA
Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in
RCF Recertification  
Approved 05/20/2022
Retrieve Notice of Action (NOA) 05/20/2022
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
  Inventory as of this Action Requested Previously Approved
05/31/2025 36 Months From Approved 05/31/2022
10,367,171 0 10,367,171
445,796 0 463,193
0 0 0



None
None



  Total Approved 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 10,367,171 10,367,171 0 0 0 0
Annual Time Burden (Hours) 445,796 463,193 0 0 -17,397 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
   
   
Uncollected
Uncollected
Uncollected
No
James Butikofer 202 693-8434 [email protected]

 

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.


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