ss_0915-0150_ 2009

Supporting Statement
Faculty Loan Repayment Program (FLRP) Applications
A. Justification
1. Circumstances of Information Collection
This is to request an extension of OMB approval of the information collection requirements and
application form for the Faculty Loan Repayment Program (FLRP) currently approved under
OMB No. 0915-0150, which expires December 31, 2009.
The Faculty Loan Repayment Program (FLRP) is governed by section 738(a) of the Public
Health Service Act (42 U.S.C. 293b), as amended by the Health Professions Education
Partnerships Act of 1998 (Pub. L.105-392). The purpose of the FLRP is to recruit individuals
from a disadvantaged background who have a health professions degree or certificate to serve as
faculty members in accredited health professions schools by offering to make partial payments
on education loan(s). The FLRP is directed at those individuals available to either; 1) serve
immediately or within a short time as "new" full-time or part-time faculty members or, 2) are
currently serving as full-time or part-time faculty members.
In exchange, the graduate health professional agrees to have a contract with an accredited health
professions school to serve as a full-time or part-time faculty member for a minimum of 2 years.
Loan repayment agreements are approved by the Secretary for eligible undergraduate and
graduate health professional educational loans incurred with government or commercial lending
institutions.
All FLRP application information is electronic and is essential to determine the applicants’
eligibility and the creditability of existing undergraduate and/or graduate health professional
educational loans.
This collection of information is necessary to enable HRSA to respond to The President's
Management Agenda, which calls for government reform that is citizen-centric, results-oriented
and market-based and requires agencies to participate in e-Government initiatives that provide
high quality customer service, provide citizens with readier access to government services,
increase access for persons with disabilities to agency Web sites and make government more
transparent and accountable ().

2. Purpose and Use of Information
The applicant completes and submits an electronic application that identifies for the Secretary
that the applicant is a disadvantaged health professions graduate who has a contract with an
accredited health professions school to serve as a full-time or part-time faculty member for a
minimum of 2 years and has valid outstanding educational loans. In addition, for each
undergraduate and/or graduate loan for which repayment is sought, the applicant is required to
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submit promissory notes verifying the establishment of the educational loan(s) and lender
statements identifying the current balance of the outstanding educational loan(s). After thorough
review of the applications, participants are selected.
The information is needed in order to determine that applicants are in compliance with
requirements of the FLRP and that the evidence submitted to the FLRP is satisfactory to the
Secretary before entering into an agreement for repayment of undergraduate and/or graduate
health professions loans. Applicants are required to submit promissory notes verifying the
original loan amount and date, and lender statements identifying the current Principal & Interest
of their outstanding educational loan(s).
The terms and conditions for participating in the FLRP are set forth in the contract between the
individual and the Secretary. In addition, the contract includes the relevant statute authorizing
the operation of the FLRP.
3. Use of Improved Information Technology
Currently, all FLRP materials are available on the Internet. FLRP guidance and application
materials have been integrated into a website for easier access by the public. Program staff
members are available to answer inquiries via telephone and e-mail. This website provides the
purpose and goal of the program. A program overview, eligibility and employer requirements
are featured, as well as Frequently Asked Questions. Every phase of the FLRP is covered on this
website, which is easily accessible 24-hours a day. During application sessions, the application
can be obtained from the site.1
4. Efforts to Identify Duplication
The information requested in the application is specific to the applicant and unique to this
program.
5. Involvement of Small Entities
The information collection does not involve small businesses or other small entities.
6. Consequences If Information Collected Less Frequently
The FLRP requests the information once from each applicant. Without this information, the
program would be unable to determine applicant eligibility.
7. Consistency with the Guidelines in 5 CFR 1320.5(d)(2)
This information collection fully complies with the guidelines in 5 CFR 1320.5(d)(2).
1 FLRP Website: http://bhpr.hrsa.gov/dsa/flrp/

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8. Consultation Outside the Agency
The notice required by 5 CFR 1320.8(d) was published in the Federal Register on December 22,
2008, Volume 73, No. 246, page 78373. No comments were received. The 30 day notice was
published on June 9, 2009, Volume 74, No. 109, page 27322.
The individuals listed below were contacted by program staff to verify the burden associated
with the FLRP application. They reported no particular difficulty in completing the form, and no
change in the estimated burden for completing the form. The following individuals did allow
that the site was user friendly and a very easy process to follow. It was reported that the
gathering of the loan documents and the documentation from their institution was more time
consuming.
Applicants:
Sandra A. Billinger
University of Kansas Medical Center
3901 Rainbow Blvd.
Kansas City, KS 66160
(913) 945-6685
Millicent K. Channell
University of Medicine and Dentistry of New Jersey
42 East Laurel Rd.
Stratford, NJ 08084
(856) 566-2745
9. Remuneration of Respondents
Respondents will not be remunerated.
10. Assurance of Confidentiality
The Right to Financial Privacy Act (RFPA), Pub. L. 95-630, regulates any financial institution
that provides a Federal agency with access to information contained in the financial records of a
customer. Section 1102(a) prohibits government access to financial records unless one of five
procedures is used and the records are "reasonably described." The procedure being used by
FLRP requires the applicant to submit promissory notes that verifies the establishment of the
loan(s) and lender statement(s), which identifies the current loan balance(s), verifies the
applicant’s address and provides the applicant’s Social Security Number. All applicants comply
with this requirement.
A Privacy Act Notification Statement is included on the FLRP website which describes the
purposes of the information collection and the potential disclosures. A Privacy Act System of
Records, #09-15-0058, has been established for the Faculty Loan Repayment Program,
HHS/HRSA/BHPr. The disclosure of the applicant's Social Security Number (SSN) is required
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by section 4 of the Debt Collection Act of 1982 (26 U.S.C. 6103) and the applicant provides this
information on his/her lender statement(s). The disclosure of the Social Security Number is
required for participation in the program, since the amounts repaid to lenders must be reported to
the Internal Revenue Service as "other income" on IRS Form 1099. Safeguards are followed
concerning the use of the SSN in the Privacy Act of 1974 (5 U.S.C. 552a note).
11. Questions of a Sensitive Nature
There are no questions of a sensitive nature.
12. Estimates of Annualized Hour Burden
The estimated average hour burden and hour cost is as follows:

Form

Number of
Responses

Responses
Per
Responses

Total
Annual
Responses

Hours per
Response

Total
Hour
Burden

Dollar
Wage
Rate

Total
Hour
Cost

Applicants

181

1

181

6

1,086

$59

$63,012

Form Name
Application
Institution
Employment
Form
Loan
Information and
Verification
Form
Checklist Form
BCRSIS
Online Banking
Form

Responses
Number of
per
Hours per
Respondents Respondent Response
181
1
1

Total
Burden
Hours
181

Wage
Rate
$59

Total Hour
Cost
$10,679

181*

1*

1

181

$59

$10,679

181

3

3

543

$59

$32,037

181
181

1
1

.50
.50

90.50
90.50

$59
$59

$5,339.50
$5,339.50

362

1,086

$64,074

TOTAL
*Respondent for this form is the academic institution for the applicant.

Basis for Burden: Applications are for service as faculty health professionals and 181
applications were submitted in 2008, an increase from previous years. The burden per response
has increased from one hour to four hours. A justification for the increase in burden is in section
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15. Please note that due to the way this package has been submitted in ICRAS, the number of
responses reflects an incorrect and inflated number (905). The true number of respondents is
reflected in this burden table (362: 181 applicants and 181 academic institutions).
13. Estimates of Annual Cost Burden to Respondents
There are no capital and start-up costs because the applicants incur no costs other than their time.
14. Estimates of Annualized Cost to the Government
The annual cost to the government is approximately $64,074 for 75% time for one FTE GS 14
employee to process the applications and facilitate team members in the loan repayment process.
15. Change in Burden
The current total burden hour for this activity in the OMB inventory is 160 hours. This request
is for 1,068 hours, an increase of 908 hours. This increase is a program adjustment due to an
expectation of an increase in the number of individuals participating in the program, the number
of loans each applicant submits, and the applicants’ requirement to obtain documentation from
the employing institution (per the OIG Report January 2002 Faculty Loan Repayment Program –
Making More Effective use of Program Funds OEI-12-01-00510 – Attachment C). Additionally,
the program is adding a FLRP checklist for applicants estimated to add 91 burden hours to the
ICR as part of the increase; this is a program change due to agency discretion.
16. Time Schedule, Publication, and Analysis Plans
There are no plans for the tabulation, statistical analysis or publication of the information.
17. Exemption for Display of Expiration Date
The expiration date will be displayed.
18. Certifications
This information collection fully complies with the guidelines in 5 CFR 1320.9. The
certifications are included in the package.
Attachments
Attachment A – Legislation
Attachment B – FLRP Forms, Including: Application, Application Checklist, Loan Information
and Verification Form, and Institution Employment/Loan Repayment Verification
Attachment C – OIG Report

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