Start-up & Solvency Loan Application

Consumer Operated and Oriented Plan [CO-OP] Program

OMB: 0938-1139

IC ID: 198650

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Start-up & Solvency Loan Application
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 156

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10392 CO-OP FOA CMS-10392.CO-OP FOA (12-9-11).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

27 27
   
Private Sector Not-for-profit institutions
 
   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 27 0 0 8 0 19
Annual IC Time Burden (Hours) 13,932 0 0 4,128 0 9,804
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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