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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1139
ICR Reference No:
201504-0938-015
Status:
Historical Active
Previous ICR Reference No:
201411-0938-013
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Consumer Operated and Oriented Plan [CO-OP] Program (CMS-10392)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
05/29/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/28/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2018
36 Months From Approved
01/31/2018
Responses
802
0
710
Time Burden (Hours)
93,320
0
89,272
Cost Burden (Dollars)
0
0
0
Abstract:
The data collection in this package includes requirements associated with the Consumer Operated and Oriented Plan [CO-OP] Program, which includes Loan applications; Reconsideration requests and appeals; Loan Agreement acceptance and execution; Milestone updates; Financial reports; Progress reports; Enhanced financial and progress reports; Audits; and Recordkeeping.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 1322
Name of Law: Affordable Care Act
Citations for New Statutory Requirements:
PL: Pub.L. 112 - 240 644 Name of Law: American Taxpayer Relief Act of 2012
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
80 FR 5118
01/30/2015
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 23011
04/24/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
12
IC Title
Form No.
Form Name
Standard Reporting Before Loan Repayment - Start-up/Solvency Loan(s) Recipients
CMS-10392, CMS-10392
Reporting Templates
,
CO-OP FOA
Audits
CMS-10392
CO-OP FOA
Core Contracts
CMS-10392
CO-OP FOA
Disbursement Requests
CMS-10392
CO-OP FOA
Enhanced Reporting (Before Loan Repayment) - Start-up/Solvency Loan Recipients
CMS-10392, CMS-10392, CMS-10392, CMS-10392, CMS-10392, CMS-10392
Reporting Templates
,
CO-OP FOA
,
Monthly Reporting Guidance
,
Monthly Reporting Template
,
Semi-Annual Reporting Template
,
Quarterly Financial Report
Loan Agreement Acceptance
CMS-10392
CO-OP FOA
Reconsiderations & Appeals
CMS-10392
CO-OP FOA
Recordkeeping
CMS-10392
CO-OP FOA
Request for additional funding
CMS-10392
CO-OP FOA
Standard Reporting After Loan Repayment - Start-up/Solvency Loan Recipients
CMS-10392, CMS-10392
Reporting Templates
,
CO-OP FOA
Start-up & Solvency Loan Application
CMS-10392
CO-OP FOA
Updated Business Plans
CMS-10392, CMS-10392, CMS-10392
CO-OP FOA
,
Project Plan without Resources
,
Project Plan with Resources
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
802
710
0
92
0
0
Annual Time Burden (Hours)
93,320
89,272
0
4,048
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
CO-OPs are required to provide annual pro forma financial projections to CMS on March 1. At CMS's discretion, the pro forma financial projections may be requested on a semi-annual basis. The guidance for this is included in the semi-annual reporting tool which is submitted to CMS on March 1 and August 15. Pro forma financial projections aid CMS in determining whether a CO-OP is a financial risk. As the lender to the CO-OPs, CMS has a vested interest in a given CO-OP's financial viability. As such, we are requiring an additional reporting requirement to collect pro forma financial projections (including monthly cash flow projections for 18 months from the date of submission) on a quarterly basis. Furthermore, CMS is amending the monthly reporting guidance to clarify current requirements and include additional data elements necessary for CMS to conduct appropriate oversight over the CO-OP program. The additional quarterly reporting requirements will increase the total burden from 89,272 hours annually to 93,320 hours annually. Please note that there is no change in the burden for the additional data elements in the monthly reporting requirements as this information is readily available to the CO-OPs on a monthly basis.
Annual Cost to Federal Government:
$623,949
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Jamaa Hill 301 492-4190
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
04/28/2015
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