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OMB Control Number: 09381401 Expiration Date: xx/xx/xxxxSurprise Billing Protection Form This document describes your protections against unexpected medical bills. It also asks if you'd like to give
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How to fill out your rights and protections

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Understand what rights and protections you are entitled to.
02
Research the laws and regulations that apply to your situation.
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Seek legal advice if you are unsure about your rights.
04
Keep documentation and records of any interactions related to your rights.
05
Take action to enforce your rights if they are being violated.

Who needs your rights and protections?

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Everyone needs their rights and protections to ensure fair treatment and justice.
02
Specifically, individuals facing discrimination, harassment, or other injustices may need to rely on their rights and protections to seek redress.
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Your rights and protections include the right to privacy, freedom of speech, and protection from discrimination.
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The purpose of your rights and protections is to ensure that individuals are treated fairly and have access to necessary protections.
You must report information such as your personal details, any incidents of discrimination or violations of your rights, and any relevant supporting documentation.
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