Information Collection

Standard Reporting Before Loan Repayment - Start-up/Solvency Loan(s) Recipients

IC 198653 under ICR 201411-0938-013 · OMB 0938-1139.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1139 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10392 Standard Reporting Before Loan Repayment - Start-up/Solvency Loan(s) Recipients Form and Instruction
CMS-10392 Reporting Templates CMS-10392.CO-OP Reporting Template.docx Form and Instruction
CMS-10392 CO-OP FOA CMS-10392_CO-OP_FOA_(final).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Standard Reporting Before Loan Repayment - Start-up/Solvency Loan(s) 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 and Instruction	CMS-10392	CO-OP FOA	CMS-10392_CO-OP_FOA_(final).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 23

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

Percentage of Respondents Reporting Electronically: 98 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	276	-336	612
Annual IC Time Burden (Hours)	5,520	-6,108	11,628
Annual IC Cost Burden (Dollars)	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.