No Surprises Act: IDR Process

OMB 1210-0169

OMB 1210-0169

Latest Forms, Documents, and Supporting Material

Document Name
1210-0169 Tri-dept PRA supporting statement 11.13.2025 .docx Supporting Statement A
IDR- No Material Justification 02-24-2023.docx Justification for No Material/Nonsubstantive Change
Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment Other-Disclosure Requirement
Request of Extension of Time Periods for Extenuating Circumstances Other-Request of Extension of Time Periods for Extenuating Circu
IDR Entity Certification and IDR Entity Monthly Reporting Other-IDR Certification Application
Federal IDR Process for Air Ambulance Services Other-Notice of Open Negotiation
Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities Other-Notice of Open Negotiation

All Historical Document Collections

202508-1210-009	Extension without change of a currently approved collection	2025-11-26
202305-1210-002 Comment filed on proposed rule and continue	Revision of a currently approved collection	2023-11-03
202302-1545-001CF Approved	RCF Recertification	2023-02-24
202302-1210-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-02-24
202302-0938-001CF Approved	RCF Recertification	2023-02-24
202211-1545-003CF Approved	RCF Recertification	2022-11-14
202211-0938-001CF Approved	RCF Recertification	2022-11-14
202207-1210-004 Approved with change	Revision of a currently approved collection	2022-08-26
202206-1545-001CF Approved	RCF Recertification	2022-06-15
202206-0938-001CF Approved	RCF Recertification	2022-06-15
202204-1545-001CF Approved	RCF Recertification	2022-04-11
202204-1210-002 Approved with change	Revision of a currently approved collection	2022-04-25
202204-0938-001CF Approved	RCF Recertification	2022-04-11
202203-1545-007CF Approved without change	RCF New	2022-03-21
202202-1210-002 Approved with change	Revision of a currently approved collection	2022-04-05
202110-1210-002 Approved without change	Revision of a currently approved collection	2021-10-07
202110-0938-001CF Approved without change	RCF New	2021-10-21
202108-1210-008 Preapproved	New collection (Request for a new OMB Control Number)	2021-10-01

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