Patient Protection and Affordable Care Act Patient Protection Notice

OMB 1545-2181

The Patient Protection Notice is used by health plan sponsors and issuers to notify certain individuals of their right to (1) choose a primary care provider or a pediatrician when a plan or issuer requires participants or subscribers to designate a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.

The latest form for Patient Protection and Affordable Care Act Patient Protection Notice expires 2020-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
2022 SS 1545-2181.docx Supporting Statement A
Patient Protection and Affordable Care Act Patient Protection Notice (TD 9951)

All Historical Document Collections

202204-1545-012 Approved without change	Extension without change of a currently approved collection	2022-06-29
202111-1545-007 Approved without change	Reinstatement without change of a previously approved collection	2021-12-01
201705-1545-040 Approved without change	Revision of a currently approved collection	2017-07-17
201311-1545-019 Approved without change	Extension without change of a currently approved collection	2014-02-27
201011-1545-040 Approved without change	Extension without change of a currently approved collection	2010-12-29
201008-1545-022 Approved without change	Revision of a currently approved collection	2010-08-12
201006-1545-037 Preapproved	New collection (Request for a new OMB Control Number)	2010-06-18