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OMB Control No: 1210-0169	ICR Reference No: 202606-1210-003
Status: Received in OIRA	Previous ICR Reference No: 202508-1210-009
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: No Surprises Act: IDR Process
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: Yes
Type of Review Request: Emergency	Approval Requested By: 06/12/2026
Date Submitted to OIRA: 06/09/2026

	Requested	Previously Approved
Expiration Date	6 Months From Approved	06/30/2029
Responses	5,434,447	2,755,048
Time Burden (Hours)	3,539,442	1,691,251
Cost Burden (Dollars)	78,907,282	58,518,032

Abstract: The CAA added provisions applicable to group health plans and health insurance issuers in the group and individual markets in a new Part D of title XXVII of the Public Health Service Act (PHS Act) and also added new provisions to part 7 of the Employee Retirement Income Security Act (ERISA), and Subchapter B of chapter 100 of the Internal Revenue Code (Code). Section 102 of the No Surprises Act added Code section 9816, ERISA section 716, and PHS Act section 2799A-1, which contain limitations on cost sharing and requirements for initial payments for emergency services. Section 103 of the No Surprises Act amended Code section 9816, ERISA section 716, and PHS Act section 2799A-1 to establish a Federal independent dispute resolution (Federal IDR) process that nonparticipating providers or facilities and group health plans and health insurance issuers in the group and individual market may use following the end of an unsuccessful open negotiation period to determine the out-of-network rate for certain services. More specifically, the Federal IDR provisions may be used to determine the out-of-network rate for certain emergency services, nonemergency items and services furnished by nonparticipating providers at participating health care facilities, where an All-Payer Model Agreement or specified state law does not apply. Section 105 of the No Surprises Act created Code section 9817, ERISA section 717, and PHS Act section 2799A-2 which contain limitations on cost sharing and requirements for initial payments for air ambulance services, and allow plans and issuers and providers of air ambulance services to access the Federal IDR process. CAA provisions that apply to health care providers and facilities, and providers of air ambulance services, such as requirements around cost sharing, prohibitions on balance billing for certain items and services, and requirements related to disclosures about balance billing protections, were added to title XXVII of the PHS Act in a new part E.

Emergency Justfication: The ROCIS system was only allowing us to submit this information collection as an emergency. This is not a emergency, but the rule was published on 6/04/2026. We are looking for a three-year approval.

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

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AC17	Final or interim final rulemaking	91 FR 33900	06/04/2026

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? Yes

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	5,434,447	2,755,048	2,679,399
Annual Time Burden (Hours)	3,539,442	1,691,251	1,848,191
Annual Cost Burden (Dollars)	78,907,282	58,518,032	20,389,250

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: The Department has made the following changes to the information collection: • The Departments have updated the number of IDR disputes that would be submitted annually as part of the Federal IDR process from 22,000 disputes to 2,600,000 disputes. Therefore, the hour burden has significantly increased. • The Departments have updated the wage rates and mailing costs. • 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. • 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. The Departments have also removed the following forms, as they will be included in the following HHS PRA package, “Patient Provider Dispute Resolution Requirements Related to Surprise Billing: Part II (CMS-10853)”: o Standard Form: Patient-Provider Dispute Resolution (PPDR) Dispute Initiation Form o Standard Form: Online PPDR Initiation Form o Standard Notice: Ineligible for PPDR or Additional Information Needed o Patient-Provider SDR Entity Certification Application Data Elements o Independent Dispute Resolution and PPDR; Vendor Management Data Elements. o PPDR Process Data Elements o Standard Notice: SDR Determination Notice to Parties Provided Under the No Surprises Act o Standard Notice: SDR Entity Notification to Health Care Providers and Facilities and Uninsured (or Self-Pay) Individuals o Standard Notice: Uninsured (or Self-Pay) Individual and Provider or Facility Settle on a Payment Amount After Initiating Patient Provider Dispute Resolution. o Standard Notice: SDR Entity Notification to Health Care Provider or Facility and Uninsured (or Self-Pay) Individual Confirming Receipt of Dispute Settlement and Action o Standard Notice: Uninsured (or Self-Pay) Individual, Provider or Facility’s Notification to Secretary of Health and Human Services Furthermore, the Departments have removed the form, “Good Faith Estimates Template Notice,” as the form has been included in HHS OMB Control Number 0938-1433. As a result, the number of responses has increased by 2,679,399 responses, the hour burden has increased by 1,848,191 hours, and the cost burden has increased by $20,389,250.

Annual Cost to Federal Government: $1,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: James Butikofer 202 693-8434 Butikofer.James@dol.gov

Common Form ICR: Yes
Description/Changes for Common Form Usage: • 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. • 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.

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