Faculty Loan Repayment Program Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 001_FLRP Faculty Loan Repayment Program Application	Form	Modified	Available
Form 004_FLRP FLRP Online Banking Form	Form	New	Available
Form 004_FLRP Loan Information and Verification Form	Form	New	Available
Form 003_FLRP FLRP Institution Employment-Loan Repayment Form	Form	New	Available
Form 002-FLRP FLRP Checklist	Form	New	Available
OIG Report_oei-12-01-00510.pdf	Supplementary Document	Uploaded 2009-06-12	Available
ss_0915-0150_ 2009.pdf	Supporting Statement A	Uploaded 2009-07-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6381	Faculty Loan Repayment Program Application	Form	Modified
189999	FLRP Online Banking Form	Form	New
189998	Loan Information and Verification Form	Form	New
189997	FLRP Institution Employment-Loan Repayment Form	Form	New
189996	FLRP Checklist	Form	New

ICR Details

OMB Control No: 0915-0150	ICR Reference No: 200907-0915-001
Status: Historical Active	Previous ICR Reference No: 200609-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Faculty Loan Repayment Program Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/13/2009
	Date Received in OIRA: 07/21/2009
Terms of Clearance: Approved consistent with clarification that this package is, in fact, a revision to the previous package.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	36 Months From Approved	12/31/2009
Responses	905	0	160
Time Burden (Hours)	1,087	0	160
Cost Burden (Dollars)	0	0	0

---

Abstract: The purpose of the Faculty Loan Repayment Program is to attract disadvantaged health professionals into faculty positions in accredited health professions schools by offering to make partial payments on education loans. In exchange, the graduate health professional agrees to have a contract with an accredited health professions school to serve as a faculty member for a minimum of two years.

---

Authorizing Statute(s): PL: Pub.L. 105 - 392 738(a) Name of Law: Health Professions Education Partnerships Act of 1998
   US Code: 42 USC 293b Name of Law: Public Health Service Act
  

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 78373	12/22/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 27322	06/09/2009
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Faculty Loan Repayment Program Application	001_FLRP	FLRP_Application
FLRP Checklist	002-FLRP	002-FLRP
FLRP Institution Employment-Loan Repayment Form	003_FLRP	FLRP_Inst Empl Repayment Form
Loan Information and Verification Form	004_FLRP	Loan Information and Verification Form
FLRP Online Banking Form	004_FLRP	Online Banking Form

---

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	905	160	0	181	564	0
Annual Time Burden (Hours)	1,087	160	0	91	836	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is a program change because we are adding a checklist which has added approximately 91 hours. This checklist was not previously part of the ICR. There is a program adjustment due to an expected increase in the number of applications to the program due to increased marketing and outreach of the program.

---

Annual Cost to Federal Government: $64,074

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)? No

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: 07/21/2009

---