Consumer Operated and Oriented Plan [CO-OP] Program

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
198657	Recordkeeping	New
198656	Audits	New
198655	Enhanced Reporting (Before Loan Repayment) - Start-up/Solvency Loan Recipients	New
198654	Standard Reporting After Loan Repayment - Start-up/Solvency Loan Recipients	New
198653	Standard Reporting Before Loan Repayment - Start-up/Solvency Loan(s) Recipients	New
198652	Loan Agreement Acceptance	New
198651	Reconsiderations & Appeals	New
198650	Start-up & Solvency Loan Application	New

ICR Details

OMB Control No: 0938-1139	ICR Reference No: 201107-0938-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Consumer Operated and Oriented Plan [CO-OP] Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/27/2011
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/27/2011
	Date Received in OIRA: 07/26/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	6 Months From Approved
Responses	876	0	0
Time Burden (Hours)	31,998	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This request includes the collections associated with the Consumer Operated and Oriented Plan (CO-OP) program, will provide nonprofits with loans to fund start-up costs and State reserve requirements, in the form of Start-up Loans and Solvency Loans.

Emergency Justfication: Please see the attached emergency justification.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1322 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1322 Name of Law: Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking
	Other Documents for OIRA Review

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Start-up & Solvency Loan Application	CMS-10392
Reconsiderations & Appeals	CMS-10392
Loan Agreement Acceptance	CMS-10392
Standard Reporting Before Loan Repayment - Start-up/Solvency Loan(s) Recipients	CMS-10392
Standard Reporting After Loan Repayment - Start-up/Solvency Loan Recipients	CMS-10392
Enhanced Reporting (Before Loan Repayment) - Start-up/Solvency Loan Recipients	CMS-10392
Audits	CMS-10392
Recordkeeping	CMS-10392

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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	876	0	876	0	0	0
Annual Time Burden (Hours)	31,998	0	31,998	0	0	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: This is a new collection.

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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

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Common Form ICR:  No

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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: 07/26/2011

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