View Information Collection (IC)

View Information Collection (IC)

IC Title:	Enhanced Reporting (Before Loan Repayment) - Start-up/Solvency Loan Recipients	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 156

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10392	Reporting Templates	CMS-10392.CO-OP Reporting Template.docx		Yes	Yes	Fillable Fileable
Form	CMS-10392	Semi-Annual Report	CMS-10392 - Semi-Annual Report.accdb		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10392	Quarterly Financial Report	CMS-10392 - CO-OP Program Quarterly Financial Report Access Database 9-21-12 (2).mpp		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10392	CO-OP FOA	CMS-10392_CO-OP_FOA_(final).pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 10

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 98 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	20	0	0	0	0	20
Annual IC Time Burden (Hours)	60	0	0	0	0	60
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.