Nurse Faculty Loan Program - Program Specific Data Form

Forms and Documents

Document Name	Status
Form NFLP Nurse Faculty Loan Program - Program Specific Data Form Form	New
ss nflp data form.pdf Supporting Statement A	2008-09-10

IC Document Collections

IC ID	Document Title	Status
186652	Nurse Faculty Loan Program - Program Specific Data Form Form	New

ICR Details

OMB Control No: 0915-0321	ICR Reference No: 200809-0915-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Nurse Faculty Loan Program - Program Specific Data Form
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/27/2008
	Date Received in OIRA: 09/18/2008
Terms of Clearance: This ICR is approved. Though the form appears to be self-explanatory and nursing schools seem to be familiar with it, HRSA may wish to consider providing instructions to accompany the form in the future.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	36 Months From Approved
Responses	150	0	0
Time Burden (Hours)	1,200	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a request for OMB approval of a new form, the Nurse Faculty Loan Program (NFLP) Program Specific Data Form, used to collect information from schools of nursing to apply for a student loan fund. The program is operated out of the Bureau of Health Professions in the Health Resources and Services Administration (HRSA).

---

Authorizing Statute(s): US Code: 42 USC 201 Name of Law: Nurse Reinvestment Act
   PL: Pub.L. 107 - 205 203 Name of Law: Nurse Faculty Loan Program
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 16316	03/27/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 52393	09/09/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Nurse Faculty Loan Program - Program Specific Data Form	NFLP	Nurse Faculty Loan Program - Data Form

---

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	150	0	0	0	0	150
Annual Time Burden (Hours)	1,200	0	0	0	0	1,200
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:

---

Annual Cost to Federal Government: $12,444

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 09/18/2008

---