Form NFLP AOR NFLP AOR NFLP AOR

OMB Number: 0915-xxxx

Expiration Date: ________

NURSE FACULTY LOAN PROGRAM

Annual Operating Report Period: July 1, _____ through June 30, ______

OPSID NUMBER: _____________ INSTITUTION: _______________________________________

STUDENT BORROWER DATA SECTION

Current Student Data:

1. Number of NFLP Student Borrowers Enrolled (Between 07/01/xxxx to 06/30/xxxx):

MSN: In-State ______ Out-of-State ______ DOCTORAL: In-State ______ Out-of-State ______

2. Total Number of NFLP Graduates (Between 7/01/xxxx to 6/30/xxxx): MSN ______ Doctoral ______

3. Total Number of NFLP Graduates Employed as Nurse Faculty (Between 7/01/xxxx to 6/30/xxxx) ______

4. Total Amount of Loans Made to NFLP Borrowers (Between 7/01/xxxx to 6/30/xxxx): $___________

Cumulative Student Data:

5. Cumulative Number of NFLP Student Borrowers (7/1/2003 to present):

MSN: In-State ______ Out-of-State ______ DOCTORAL: In-State ______ Out-of-State ______

6. Cumulative Number of NFLP Graduates (7/1/2003 to present): MSN ______ Doctoral ______

7. Cumulative Number of NFLP Graduates Employed as Nurse Faculty (7/1/2003 to present): ______

8. Cumulative Amount of Loans Made to NFLP Borrowers $_____________

9. ETHNICITY/RACE OF NFLP RECIPIENTS and GRADUATES (Between July 1, xxxx – June 30, xxxx) (Column totals must coincide with the numbers reported for items #1, 2 and 3 above.)

ETHNICITY		# of NFLP Recipients Enrolled -- Did Not Graduate	# of NFLP MSN Graduates	# of NFLP Doctoral Graduates	# of NFLP Graduates Employed As Full-time Nurse Faculty
	Hispanic or Latino
	Not Hispanic or Latino
	Totals:
RACE		NFLP Recipients Enrolled -- Did Not Graduate	# of NFLP MSN Graduates	# of NFLP Doctoral Graduates	# of NFLP Graduates Employed As Full-time Nurse Faculty
A.	American Indian or Alaska Native
B.	Asian
C.	Black or African American
D.	Native Hawaiian or Pacific Islander
E.	White
F.	More Than One Race
G.	Unavailable/Unreported
Totals:

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0915-xxxx.  Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:  HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

Page 1 of 4

NFLP ANNUAL OPERATING REPORT

Period: July 1, _____ through June 30, ______

PROGRAM ACCOUNTS			Cumulative	Current Year
A.	FEDERAL FUNDS (FCC) AWARDED
B.	CASH BALANCE - START OF REPORT PERIOD		XXXXXX
C.	CASH RECEIPTS
	1.	Federal Capital Contribution (FCC) Drawn-Down from PMS & Deposited
	2.	Institutional Capital Contribution (ICC) Deposited
	3.	Loan Principal Collected
	4.	Interest Income Collected on Loans
	5.	Penalty Charges Collected on Loans
	6.	Investment Income
	7.	Institutional Repayments of Bad Debts, Principal
	8.	Institutional Repayments of Bad Debts, Interest
	9.	Institutional Repayments of Bad Debts, Penalty Charges
	10.	CASH RECIEPTS TOTAL (Add items C.1 through C.9)
D.	TOTAL AMOUNT IN NFLP FUND (Add items B and C.10)
E.	CASH DISBURSEMENTS
	1.	NFLP Loans to Students
	2.	Repayments to Federal Government, Principal
	3.	Repayments to Federal Government, Interest
	4.	Repayments to Federal Government, Other Income
	5.	Repayments to Institution, Principal
	6.	Repayments to Institution, Interest
	7.	Repayments to Institution, Other Income
	8.	Collection Agent Costs, Principal
	9.	Collection Agent Costs, Interest
	10.	Litigation Costs, Principal
	11.	Litigation Costs, Interest
	12.	Other Costs
	13.	CASH DISBURSEMENTS TOTAL (Add items E.1 through E.12)
F.	1.	CASH BALANCE – END OF REPORT PERIOD (Subtract item E.13 from D):	XXXXXX
	2.	UNUSED ACCUMLATION = Item A + (Item A ÷ 9) + Item C.10 − Item E.13		XXXXXX

Page 2 of 4

EXHIBIT B-1

NURSE FACULTY LOAN PROGRAM

Annual Operating Report Period: July 1, _____ through June 30, ______

PROGRAM ACCOUNTS SECTION (Continued)

PROGRAM ACCOUNTS (Continued)				Cumulative			Current Year
				Number of Borrowers	Principal	Interest	Number of Borrowers	Principal	Interest
G.	LOAN CANCELLATIONS TO BORROWERS
	1.	Nursing Employment
		a.	Nursing Employment –Yr. 1 (20%)
		b.	Nursing Employment –Yr. 2 (20%)
		c.	Nursing Employment –Yr. 3 (20%)
		d.	Nursing Employment –Yr. 4 (25%)
	2.	Death of Borrower
		On NFLP Loans made on or after 7/22/2003
	3.	Permanent & Total Disability Approved by HHS
		On NFLP Loans made on or after 7/22/2003

H.	BAD DEBTS APPROVED FOR WRITE-OFF BY HHS	Number of Borrowers	Principal	Interest	Penalty Charges	Number of Borrowers	Principal	Interest	Penalty Charges
	Total Approved

I. CLOSING SCHOOLS

2. Amount of cash determined to be due the Federal Government and remitted separately to the

Division of Financial Operations: ______________

J. AUDITS

1. Does your institution provide for a biennial audit of the loan funds by a qualified independent auditor?

_______Yes ______No ______N/A

Page 3 of 4

EXHIBIT B-1

STATUS OF ALL BORROWER ACCOUNTS AS OF JUNE 30, _______________ (BORROWER ACCOUNTS WORKSHEET)

PRINCIPAL CANCELLED

BORROWER ACCOUNTS

Number of Borrowers

Principal Loaned

Principal Repaid

Upon Employment as Nurse Faculty

Upon Death/ Disability

Principal Delinquent

Principal Uncollectible Not Past Due

Principal Outstanding but Not Due

Principal Written Off

1.

FULLY RETIRED

A.

Repayment/Cancellation

B.

Cancellation/Death

C.

Cancellation/Disability

D.

Discharged in Bankruptcy

E.

HHS Approved Write-off

F.

Uncollectible per P.L. 107-205

2.

CURRENT

A.

Student Status

B.

Grace Period

C.

Deferment Status

D.

Postponement/Cancellation

E.

Repayment – Not Past Due

F.

Past Due 1-119 Days

3.

IN BANKRUPTCY

A.

Per Discharge/Wage Earners Agreement

4.

IN DEFAULT

A.

120 Days and Over

5. FORBEARANCE

A.

Forbearance

TOTAL:

_________________________________________________________________________________________ __________________________

Signature of Authorized Official or Person Acting on behalf of the Authorized Official at the Institution DATE

Page 4 of 4

Nurse Faculty Loan Program (NFLP)

ANNUAL OPERATING REPORT (AOR) INSTRUCTIONS

Student Borrower Data Section - Page 1

CURRENT STUDENT DATA

Item 1: Number of NFLP Student Borrowers Enrolled: Indicate the total number of continuing and new students who received NFLP support between July 1, xxxx and June 30, xxxx for MSN and/or Doctoral students by in-state and out-of-state.

Item 2: Number of NFLP Graduates: Indicate the total number NFLP borrowers who graduated between July 1, xxxx and June 30, xxxx by education level (MSN and Doctoral).

Item 3: Number of NFLP Graduates Employed as Nurse Faculty: Indicate the total number NFLP graduates that were employed as full-time nurse faculty between July 1, xxxx and June 30, xxxx by education level (MSN and Doctoral).

Item 4: Total Amount of Loans Made: Indicate the total dollar amount of NFLP loans made to students between July 1, xxxx and June 30, xxxx.

CUMULATIVE STUDENT DATA

Item 5: Cumulative Number of NFLP Student Borrowers: Since beginning the NFLP at your institution, indicate the total number of continuing and new students who received NFLP support for MSN and/or Doctoral students by in-state and out-of-status.

Item 6: Cumulative Number of NFLP Graduates: Since beginning the NFLP at your institution, indicate the total number NFLP borrowers who graduated by education level (MSN and Doctoral).

Item 7: Number of NFLP Graduates Employed as Nurse Faculty: Since the beginning of the NFLP at your institution, indicate the total number NFLP graduates that were employed as full-time nurse faculty by education level (MSN and Doctoral).

Item 8: Cumulative Amount of Loans Made: Since beginning the NFLP at your institution, indicate the total dollar amount of NFLP loans made to students.

Item 9: Race/Ethnicity of NFLP Recipients and Graduates (Current Reporting Period)

ETHNICITY:

1. Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino."

2. Not Hispanic or Latino

RACE:

American Indian or Alaska Native: A person having origins in any of the original peoples of North, Central, or South America, and who maintains tribal affiliation or community attachment.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American: A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

More Than One Race: A person identifying with more than one of the above racial categories.

Not Reported or Not Available

Based upon race/ethnicity of the NFLP recipients and graduates, provide the following data:

Column 1: Indicate the number of NFLP Recipients enrolled in the nursing education program between July 1, xxxx and June 30, xxxx and did not graduate.

Column 2: Indicate the number of NFLP Recipients who graduated with a Master’s degree between July 1, xxxx and June 30, xxxx.

Column 3: Indicate the number of NFLP Recipients who graduated with a Doctoral degree between July 1, xxxx and June 30, xxxx.

Column 4: Indicate the number of NFLP Graduates Employed as full-time nurse faculty between July 1, xxxx and June 30, xxxx.

Program Accounts Section – Page 2

Entries in the “Current Year” column should reflect the net totals of transactions for the current reporting period (July 1, xxxx through June 30, xxxx); and

Entries in the “Cumulative” column should reflect the totals of transactions (account balances) since the institution first began participation in the NFLP through the current reporting period.

Item A: Federal Funds Awarded: The amount should reflect the Federal Capital Contribution (FCC) amount shown on the fiscal year Notice of Award for the current year and the cumulative amount of awards made to your institution since beginning the NFLP.

Item B: Cash Balance-Start of Report Period: The amount should reflect the ending “cash balance” from the institution’s prior Annual Operating Report (AOR) for the current year only.

Item C: Cash Receipts (Funds Deposited)

Item C.1: Federal Capital Contribution (FCC) Drawn from PMS and Deposited: The amount should reflect the total FCC actually drawn down from the Payment Management System and deposited into the NFLP fund. Report the amount of the FCC drawn-down by the institution for the current year only.

Item C.2: Institutional Capital Contributions (ICC) Deposited: The amount must equal at least one-ninth of the Federal Capital Contribution funds drawn down. Report the amount of the ICC (1/9 of the total FCC) deposited into the NFLP fund for the current year only.

Item C.3: Loan Principal Collected: Report the amount of loan principal collected from borrowers for the current year and cumulative period.

Item C.4: Interest Income Collected on Loans: Report the amount of interest on loan principal collected from borrowers for the current year and cumulative period.

Item C.5: Penalty Charges Collected on Loans: Report the amount of penalty charges collected from borrowers for the current year and cumulative period.

Item C.6: Investment Income: Report the amount of earnings on NFLP funds deposited in any type of interest-bearing account for the current year and cumulative period.

Items C.7-C.9: Institutional Repayments of Bad Debts, Principal, Interest and Penalty Charges: Report the amount of any repayments of bad debt (principal, interest and penalty charges) collected for the current year and cumulative period. NOTE: Institutions have the ultimate responsibility for bad debts losses not approved for write-off by the Department of Health and Human Services (DHHS). There is nothing to prevent an institution from further pursuing the collection of a bad debt after it has been disapproved for write-off by DHHS; any amounts recovered would lessen the institution’s liability.

Item C.10: Cash Receipts Total: Report the total amount of items C.1 through C.9 for the current year and cumulative period.

Item D: Total Amount in NFLP Fund: Report the current total amount of items B and C10 for the current year only.

Item E.1: Nurse Faculty Loan Program (NFLP) Loaned Made to Students: Report the total amount of NFLP funds loaned to students for the current year and cumulative period.

Item E.2-E.4: Repayments to Federal Government - Principal, Interest and Other Income: Report the total amounts repaid to Federal Government for the current year and cumulative period. NOTE: Repayments to Federal Government is excess cash returned to the Division of Payment Management. DO NOT include amounts returned to PMS because those amounts should be adjusted against Federal Funds Received within the appropriate award period.

Item E.5: Repayments to Institution, Principal: Report the total amount of loan principal repaid to the institution for the current year and cumulative period. Example: The institution’s proportionate share of excess cash in the NFLP fund that has been repaid to the institution. DO NOT show withdrawal of funds as a result of excess institutional contributions in this item.

Item E.6: Repayments to Institution, Interest: Report the total amount of interest on student loans repaid to the institution for the current year and cumulative period.

Item E.7: Repayments to Institution, Other Income: Report the total amount of other income repaid to the institution for the current year and cumulative period. NOTE: This item would include any amounts in items C.7, C.8 and C.9 that were repaid to the institution in conjunction with a repayment to the Federal government.

Item E.8-E.11: Collection Agent Costs-Principal & Interest: The full amount of principal and interest collected must be reported in items C.3, C.4 and C.5. The associated collection costs must be prorated. See example below. Litigation Costs-Principal & Interest: Litigation costs associated with the collection of a loan and interest must be prorated in the same manner as collection costs. See example below.

The following method of reporting is required even if the collection agency and/or attorney remit only the net amount (collections less collection of litigation costs) to the institution. If the institution is able to get the borrower to pay the collection costs or the litigation costs, the costs are not charged to the fund.

EXAMPLES OF PRORATING COLLECTION COSTS (Litigation Costs to Be Prorated in Same Manner):

An institution directs a collection agency to collect $1,000.00 principal and $200.00 interest for a total of $1,200.00 from a delinquent borrower. The collection agency collects all $1,200.00 but deducts $360.00, or 30% of the amount collected, before remitting the net amount of $840.00 to the institution. The institution reports as follows:

• Loan Principal Collected $1,000.00

• Interest Income Collected 200.00

• Collection Costs, Principal (30% x $1,000) 300.00

• Collection Costs, Interest (30% x $200) 60.00

An institution directs a collection agency to collect $1,500.00 principal and $500.00 interest for a total of $2,000.00 from a delinquent borrower. At the end of the report period, the collection agency has collected $1,600.00 (80% of $2,000.00), which it remits to the institution with a bill for $480.00 (30% of the $1,600.00 collected). The institution pays the collection agency $480.00 taken from the Fund and reports as follows:

• Loan Principal Collected (80% of the $1,500) $1,200.00

• Interest Income Collected (80% of $500) 400.00

• Collection Costs, Principal (30% of $1,200) 360.00

• Collection Costs, Interest (30% of $400) 120.00

Item E.12: Other Costs: Report the total amount of other costs charged to the fund (i.e., overpayments and underpayments of $10.00 or less) for the current year and cumulative period. Note: DO NOT include administrative costs such as BILLING AGENCY COSTS, SALARIES, STAMPS, BANK CHARGES, and the like, incurred by the institution.

Item E.13: Cash Disbursement Total: Report the total amount of items E.1 through E.12 for the current year and cumulative period.

Item F.1 Cash Balance – End of Report Period: Subtract item E.13 from D. This amount should equal the actual cash on hand and in the NFLP fund for the current year only.

Item F.2 Unused Accumulation – This amount should equal the cumulative Federal funds awarded (Item A), plus the cumulative 1/9 Institutional Capital Contribution (Item A ÷ 1/9), plus the total Collections, Investments, Repayments received (Item C.10), minus the total cash disbursements from the loan fund (Item E.13). Note: If the “actual ICC is over….; if the actual ICC is under….

Program Accounts Section (Continued) -Page 3

Item G: Loan Cancellations to Borrowers

Item G.1: Nursing Employment: Under the appropriate column headings for years 1-4 Nursing Employment, report the cumulative and current number of borrowers and the amounts of principal and interest on NFLP loans.

Item G.2 Death of Borrower: Report only the information for loans made on or after July 22, 2003. Under the appropriate column headings, report the current and cumulative number of borrowers and the amounts of principal and interest that were approved for cancellation by the institution due to death.

Item G.3 Permanent and Total Disability Approved by HHS: Report only the information for loans made on or after July 22, 2003. Under the appropriate column headings, report the current and cumulative number of borrowers and the amounts of principal and interest that were approved for cancellation by DHHS due to permanent and total disability.

Item H: Bad Debts Approved for Write-off by DHHS: Report amounts approved for write-off and any subsequent collections that are received.

Item I: Closing Schools: Upon termination of institutional participation in the program, the balance in the NFLP fund will be distributed between the HHS and the School in proportion to the amounts contributed by each.

Item J: Audits: Self-explanatory.

Borrower Accounts Worksheet-Page 4

In completing this section, schools must report the status of all borrower accounts as of the end of this reporting period (June 30, xxxx) — not just the accounts that changed status during this reporting period.

COLUMNS - Description of Required Information:

• NUMBER OF BORROWERS – The number of borrowers who received loans.

• PRINCIPAL LOANED – The dollar amount of loan principal disbursed.

• PRINCIPAL REPAID – The dollar amount of loan principal and interest repaid.

• PRINCIPAL CANCELLED – Upon Employment as Nurse Faculty – the dollar amount of loan principal cancelled for employment.

• PRINCIPAL CANCELLED – Upon Death/Disability – The dollar amount of loan principal cancelled due to the death or permanent and total disability of the borrower.

• PRINCIPAL DELINQUENT – The dollar amount of loan principal that is delinquent. Include only the amount of those payments that are in deferment.

• PRINCIPAL UNCOLLECTIBLE NOT PAST DUE – The dollar amount of loan principal not past due which the school has determined to be uncollectible after exercising due diligence in the collection of loans. DO NOT duplicate any of these amounts in OUTSTANDING BUT NOT DUE column.

• PRINCIPAL OUTSTANDING BUT NOT DUE – The dollar amount of loan principal outstanding but not yet due according to the original or renegotiated repayment schedule. DO NOT duplicate any amounts in “UNCOLLECTABLE NOT PAST DUE column.

• PRINCIPAL WRITTEN OFF – The dollar amount of loan principal which has been written off pursuant to receiving written authorization from the DHHS.

ROWS - Description of Required Information:

1. FULLY RETIRED (Borrowers accounts that are closed due to full repayment/cancellation/collection, death, disability, bankruptcy, write-off, uncollectible)

1.A: Report the information pertaining to borrowers who have fully retired their loans through cash repayments and/or through cancellation for eligible employment/professional practice.

1.B: Report the information pertaining to loans that have been fully retired due to death of the borrower.

1.C: Report the information pertaining to borrowers whose loans have been fully retired due to total disability.

1.D: Report the information pertaining to borrowers who have fully retired their loans through discharge in bankruptcy and have not received write-off approval.

1.E: Report the information pertaining to borrowers whose loans have been fully retired due to DHHS approved write-off.

1.F: Report the information pertaining to borrowers whose loans are uncollectible in accordance with the HRSA Student Financial Aid Guidelines-Fiscal Management: Collections.

2. CURRENT (Borrowers accounts that are active due to based on status as – NFLP student enrollment, grace period, deferment, cancellation, repayment, past due).

2.A: Report the information pertaining to borrowers who are currently in student status working toward the degree for which they obtained their loans.

2.B: Report the information pertaining to borrowers who are currently in the grace period due to termination or completion of the course of study for which they obtained their loans.

2.C: Report the information pertaining to borrowers who are currently in deferment as specified on the NFLP Promissory Notes.

2.D: Report the information pertaining to borrowers who are currently engaged in employment that qualifies them for cancellation, who have filed a Request for Postponement of Installment Payment, and who are not past due on any payment.

2.E: Report the information pertaining to borrowers who are making payments in accordance with their repayment schedules.

2.F: Report the information pertaining to borrowers who have installments past due according through deferment or in postponement for cancellation and who are also past due on any prior payments.

3. IN BANKRUPTCY

3.A: Report the information pertaining to borrowers who are currently making payments under a wage earner’s agreement (Chapter 13 proceedings).

4. IN DEFAULT

4.A: Report the information pertaining to borrowers who are in default in their repayments (120 days and over).

5. FORBEARANCE

5.A: Report the information pertaining to borrowers who are currently in Forbearance.

TOTAL: Summarize and provide totals for the information on ALL ACCOUNTS of ALL BORROWERS who have ever received a loan through the NFLP program.

SIGNATURE: The Authorized Official at the institution or a person acting on behalf of the Authorized Official MUST sign the completed AOR.