OMB control number
Requirements Related to Surprise Billing; Part II (CMS-10791)
OMB 0938-1433 · HHS/CMS.
OMB 0938-1433
Latest Forms, Documents, and Supporting Material
Document Name |
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Form and Instruction |
Form and Instruction |
Form and Instruction |
Supporting Statement A |
Supplementary Document |
Public Comments |
Supplementary Document |
Supplementary Document |
 Appendix 1. Right to Receive a Good Faith Estimate of Expected Charges Notice_12.10.25(redline).docxSupplementary Document |
Supplementary Document |
Patient-Provider Selected Dispute Resolution Entity Recertification All Historical Document Collections
| Reinstatement with change of a previously approved collection | 2026-07-07 | ||
|
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2023-03-29 | |
|
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2023-03-21 | |
|
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2022-11-15 | |
|
Approved with change |
New collection (Request for a new OMB Control Number) | 2022-04-29 |