Complaints Submission Process under the No Surprises Act (CMS-10779)

OMB 0938-1406

Latest Forms, Documents, and Supporting Material

Document Name
Complaints Related to Surprise Billing Form and Instruction

All Historical Document Collections

202603-0938-002	Reinstatement without change of a previously approved collection	2026-03-04
202206-0938-005 Approved with change	Extension without change of a currently approved collection	2022-06-07
202108-0938-011 Approved with change	New collection (Request for a new OMB Control Number)	2021-11-24