OMB control number
Complaints Submission Process under the No Surprises Act (CMS-10779)
OMB 0938-1406 · HHS/CMS.
OMB 0938-1406
Latest Forms, Documents, and Supporting Material
Complaints Related to Surprise Billing All Historical Document Collections
| Reinstatement without change of a previously approved collection | 2026-03-04 | ||
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Approved with change |
Extension without change of a currently approved collection | 2022-06-07 | |
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Approved with change |
New collection (Request for a new OMB Control Number) | 2021-11-24 |