FLRP Institution Employment-Loan Repayment Form

Faculty Loan Repayment Program Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0150 can be found here:

Documents and Forms

Document Name Document Type
Form 003_FLRP FLRP Institution Employment-Loan Repayment Form Form
003_FLRP FLRP_Inst Empl Repayment Form FLRP_Institution Employment-Loan Repayment Form.pdf Form

Information Collection (IC) Details

IC Title:	FLRP Institution Employment-Loan Repayment Form	Agency IC Tracking Number:

Is this a Common Form?		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	003_FLRP	FLRP_Inst Empl Repayment Form	FLRP_Institution Employment-Loan Repayment Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 181	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	181	181
Annual IC Time Burden (Hours)	181	181
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.