Information Collection Request

No Surprises Act: IDR Process

ICR 202508-1210-009 · OMB 1210-0169 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Response to the Employee Benefits Security Administration (EBSA) Comment Request on Agency Information Collection Activities (1).msg Public Comments Uploaded 2025-03-07 Repair queued
1210-0169 Tri-dept PRA supporting statement 11.13.2025 .docx Supporting Statement A Uploaded 2025-11-13 Available
IDR- No Material Justification 02-24-2023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-02-24 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
254938 Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment Other-Disclosure Requirement Modified
249371 Request of Extension of Time Periods for Extenuating Circumstances Other-Request of Extension of Time Periods for Extenuating Circu Modified
248857 IDR Entity Certification and IDR Entity Monthly Reporting Other-IDR Certification Application Modified
248850 Federal IDR Process for Air Ambulance Services Other-Notice of Open Negotiation Modified
248846 Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities Other-Notice of Open Negotiation Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 06/30/2026
2,755,048 163,546
1,691,251 89,520
58,518,032 556,147





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 2,755,048 163,546 0 0 2,591,502 0
Annual Time Burden (Hours) 1,691,251 89,520 0 0 1,601,731 0
Annual Cost Burden (Dollars) 58,518,032 556,147 0 0 57,961,885 0


Reginfo record details
  Yes
  The Departments have combined the hour and cost burden for nonparticipating providers or nonparticipating emergency facilities and air ambulance providers. The Departments have also added the hour burden for the registration of group health plans and health insurance issuers. Finally, the Departments have removed the hour burden for the additional information to be shared with the initial payment or notice of denial of payment, as this burden will now be included in HHS OMB Control Number 0938-1401.
Reginfo record details
table that charts list of RCF
Agency/Sub Agency RCF ID RCF Title RCF Status IC Title