Regulatory Collection Filing

No Surprise Act: IDR Process

RCF 202206-1545-001CF · Host ICR 202204-1210-002 · OMB 1210-0169

RCF Summary

Host OMB Control No.	1210-0169
Host ICR Reference No.	202204-1210-002
Agency/Subagency	TREAS/IRS
Status	Active
Type of RCF	RCF Recertification
OIRA Conclusion Action	Approved
Date Received in OIRA	2022-06-15
Conclusion Date	2022-06-15
Related Links	OMB 1210-0169 · ICR 202204-1210-002 · Previous RCF 202204-1545-001CF · Retrieve Notice of Action (NOA)

RCF Details

View RCF - OIRA Conclusion

Title: No Surprise Act: IDR Process

Type of RCF: RCF Recertification
OIRA Conclusion Action: Approved	Conclusion Date: 06/15/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/15/2022
Terms of Clearance:

Description of Agency Usage: IRS will be using the IDR model notices for health care providers, health facilities and self-pay individuals.

Authorizing Statute(s): PL: Pub.L. 116 - 260 103 and 105 Name of Law: Consolidated Appropriations Act 2021

Annual Cost to Federal Government: $0
Agency Contact: Kevin Knopf 202 317-5500 [email protected]

Common Form Information Collections (IC) in this RCF:

IC Title	Responses	Hours	Dollars	Document Type
Federal IDR Process for Air Ambulance Services	4,497	6,746	56,040	Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities	13,743	27,074	198,254	Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
IDR Entity Certification and IDR Entity Monthly Reporting	85	0	16,608	Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
				Other
Request of Extension of Time Periods for Extenuating Circumstances	13	3	0	Other
	13	3	0	Other

RCF Summary of Burden:

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	18,338	18,338	0
Annual Time Burden (Hours)	33,823	33,823	0
Annual Cost Burden (Dollars)	270,902	276,422	-5,520

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: