Information Collection Request

No Surprise Act: IDR Process

ICR 202211-1545-003CF · 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⚠️ Notice: This information collection may be outdated.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

Forms and supporting documents for this ICR
Document	Type	Status	Availability

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

Information collection document groups
IC ID	Collection	Type	Status
252197	Request of Extension of Time Periods for Extenuating Circumstances	Other-Request of Extension of Time Periods for Extenuating Circu	Modified
252196	IDR Entity Certification and IDR Entity Monthly Reporting	Other-IDR Certification Application	Modified
252195	Federal IDR Process for Air Ambulance Services	Other-Notice of Open Negotiation	Modified
252194	Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities	Other-Notice of Open Negotiation	Modified

Record metadata
Status	Active
Agency/Subagency	TREAS/IRS
OMB Control No	1210-0169
Type of Information Collection	RCF Recertification
Previous ICR Reference No	202206-1545-001CF
Date Submitted to OIRA	2022-11-14
Requested Expiration Date	1969-12-31