The Nursing Education Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 The Nursing Education Loan Repayment Program Application	Form	Modified	Available
Form 7 Participant Semi-Annual Employment Verification Form	Form	Modified	Available
Form 6 Pre-Award Script	Form	Modified	Available
Form 2 Loan Verification Form	Form	Modified	Available
0140 nonsubstantive memo.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-02-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6368	The Nursing Education Loan Repayment Program Application	Form	Modified
182803	Participant Semi-Annual Employment Verification Form	Form	Modified
182802	Pre-Award Script	Form	Modified
182801	Application Checklist		Modified
182800	Direct Deposit Sign-up Form		Modified
182799	Applicant Employment Verification Form		Modified
182798	Loan Verification Form	Form	Modified

ICR Details

OMB Control No: 0915-0140	ICR Reference No: 200902-0915-001
Status: Historical Active	Previous ICR Reference No: 200711-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The Nursing Education Loan Repayment Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/02/2009
	Date Received in OIRA: 02/27/2009
Terms of Clearance: This IC is approved on the understanding that the only change is an increase in the number of respondents due to the Recovery Act, as per the justification memo.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	01/31/2011	01/31/2011
Responses	51,952	0	38,200
Time Burden (Hours)	40,528	0	29,800
Cost Burden (Dollars)	0	0	0

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Abstract: Approval is requested for the application and monitoring forms for the Nursing Education Loan Repayment Program (NELRP). Under the NELRP, registered nurses are offered the opportunity to enter into a contractual agreement to receive loan repayment for some of their qualifying education loan balances. This repayment is in exchange for agreeing to servie full-time as a registered nurse for 2-3 years at a health care facilitiy with a critical shortage of nurses.

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Authorizing Statute(s): US Code: 42 USC 297n Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 5 VIII Name of Law: American Recovery and Reinvestment Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 VIII Name of Law: American Recovery and Reinvestment Act

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 33233	06/15/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 60379	10/24/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Direct Deposit Sign-up Form
Application Checklist
Pre-Award Script	6	Pre-Award Script
Participant Semi-Annual Employment Verification Form	7	Emp Verification Form
The Nursing Education Loan Repayment Program Application	1	Application
Loan Verification Form	2	Loan Verification Form
Applicant Employment Verification Form

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ICR Summary of Burden

table that charts list 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	51,952	38,200	13,752	0	0	0
Annual Time Burden (Hours)	40,528	29,800	10,728	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: In response to the American Recovery and Reinvestment Act, HRSA's Nursing Education Loan Repayment Program is extending the application closing date by two weeks. This two week extension is expected to result in an additional 1,800 respondents and 10,260 total burden hours.

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Annual Cost to Federal Government: $837,294

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

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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: 02/27/2009

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