APPENDIX 3 Notice of Offer Data Elements
No Surprises Act: IDR Process
APPENDIX 3 Notice of Offer Data Elements
OMB: 1210-0169
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1210-0169 can be found here:
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pdf| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Appendix 3: Federal Independent Dispute Resolution (IDR) Process Notice of Offer |
| Subject | Surprise Billing |
| Author | Employee Benefits Security Administration - United States Depart |
| File Modified | 0000-00-00 |
| File Created | 2022-04-13 |