OMB control number
Patient Protection and Affordable Care Act Patient Protection Notice
OMB 1545-2181 · TREAS/IRS.
OMB 1545-2181
The Patient Protection Notice is used by health plan sponsors and issuers to notify certain individuals of their right to (1) choose a primary care provider or a pediatrician when a plan or issuer requires participants or subscribers to designate a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.
The latest form for Patient Protection and Affordable Care Act Patient Protection Notice expires 2020-12-31 and is listed under ICR 201705-1545-040.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 2022 SS 1545-2181.docx | Supporting Statement A |
 Patient Protection and Affordable Care Act Patient Protection Notice (TD 9951) |
Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202204-1545-012 | Extension without change of a currently approved collection | 2022-06-29 | Approved without change | |
| 202111-1545-007 | Reinstatement without change of a previously approved collection | 2021-12-01 | Approved without change | |
| 201705-1545-040 | Revision of a currently approved collection | 2017-07-17 | Approved without change | |
| 201311-1545-019 | Extension without change of a currently approved collection | 2014-02-27 | Approved without change | |
| 201011-1545-040 | Extension without change of a currently approved collection | 2010-12-29 | Approved without change | |
| 201008-1545-022 | Revision of a currently approved collection | 2010-08-12 | Approved without change | |
| 201006-1545-037 | New collection (Request for a new OMB Control Number) | 2010-06-18 | Preapproved |