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

Consumer Operated and Oriented Plan [CO-OP] Program (CMS-10392)

Documents and Forms

Document Name Document Type
Form CMS-10392 Enhanced Reporting (Before Loan Repayment) - Start-up/Solvency Loan 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
CMS-10392 Monthly Reporting Guidance CMS-10392 - Monthly Reporting Guidance 04012015 FINAL.PDF Form and Instruction
CMS-10392 Monthly Reporting Template CMS-10392 - Monthly reporting template 04012015 FINAL.pdf - Adobe Acro....pdf Form and Instruction
CMS-10392 Semi-Annual Reporting Template CMS-10392 - Semi-Annual Report.accdb Form and Instruction
CMS-10392 Quarterly Financial Report CMS-10392 - CO-OP Program Quarterly Financial Report Access Database 9-21-12 (2).mpp Form and Instruction

Information Collection (IC) Details

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	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
Form and Instruction	CMS-10392	Monthly Reporting Guidance	CMS-10392 - Monthly Reporting Guidance 04012015 FINAL.PDF	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10392	Monthly Reporting Template	CMS-10392 - Monthly reporting template 04012015 FINAL.pdf - Adobe Acro....pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10392	Semi-Annual Reporting Template	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

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	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	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.