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View Information Collection (IC) List
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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:
201201-0938-001
Status:
Historical Active
Previous ICR Reference No:
201107-0938-015
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Consumer Operated and Oriented Plan [CO-OP] Program
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
06/19/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/03/2012
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2015
36 Months From Approved
06/30/2012
Responses
883
0
876
Time Burden (Hours)
36,111
0
31,998
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:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AQ98
Final or interim final rulemaking
76 FR 77392
12/13/2011
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Standard Reporting Before Loan Repayment - Start-up/Solvency Loan(s) Recipients
CMS-10392, CMS-10392
CO-OP FOA
,
Reporting Templates
Audits
CMS-10392
CO-OP FOA
Enhanced Reporting (Before Loan Repayment) - Start-up/Solvency Loan Recipients
CMS-10392, CMS-10392, CMS-10392
Reporting Templates
,
Deliberative Document
,
CO-OP FOA
Loan Agreement Acceptance
CMS-10392
CO-OP FOA
Reconsiderations & Appeals
CMS-10392
CO-OP FOA
Recordkeeping
CMS-10392
CO-OP FOA
Standard Reporting After Loan Repayment - Start-up/Solvency Loan Recipients
CMS-10392, CMS-10392
CO-OP FOA
,
Reporting Templates
Start-up & Solvency Loan Application
CMS-10392
CO-OP FOA
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
883
876
0
0
7
0
Annual Time Burden (Hours)
36,111
31,998
0
0
4,113
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$361,706
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:
William Parham 4107864669
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:
01/03/2012
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