Information Collection Request
Requirements Related to No Surprise Billing Act, Part II (Independent Dispute Resolution Process) (CMS-10791)
ICR 202211-0938-001CF · OMB 1210-0169 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1210-0169 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 249679 |  Request of Extension of Time Periods for Extenuating Circumstances |
Other-Request of Extension of Time Periods for Extenuating Circu | Modified | |
| 249678 | IDR Entity Certification and IDR Entity Monthly Reporting |
Other-IDR Certification Application | Modified | |
| 249677 | Federal IDR Process for Air Ambulance Services |
Other-Notice of Open Negotiation | Modified | |
| 249676 | Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities |
Other-Notice of Open Negotiation | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 1210-0169 |
| Type of Information Collection | RCF Recertification |
| Previous ICR Reference No | 202206-0938-001CF |
| Date Submitted to OIRA | 2022-11-14 |
| Requested Expiration Date | 1969-12-31 |