The Nursing Education Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NELRP_001 Application Guidance and Forms	Form and Instruction	Modified	Available
Form NELRP_11 The Verification of Acceptance or Decline of Award form	Form	New	Available
Form NELRP_010 Certification Of Accreditation Status for School of Nursing Education Programs Form	Form	New	Repair queued
Form NELRP_009 Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form	Form	New	Available
Form NELRP_008 Authorization to Release Information Form	Form	New	Available
Form NELRP_004 Employment Verification for Nurse Faculty Appointment Form	Form	New	Available
Form 7 Emp Verification Form	Form	Modified	Available
Form 6 Pre-Award Script	Form	Removed	Available
Form NELRP_006 Application Checklist and Self-Verification Form	Form	Modified	Available
Form NELRP_006 Authorization for Release of Employment Information Form	Form	Modified	Available
Form NELRP_003 Employment Verification and Critical Shortage Facility Form	Form	Modified	Repair queued
Form NELRP_2 Loan Information and Verification Form	Form	Modified	Available
ss_0915-0140_1-11-11-nelrp.doc	Supporting Statement A	Uploaded 2011-01-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6368	The Nursing Education Loan Repayment Program Application	Instruction	Modified
6368	The Nursing Education Loan Repayment Program Application	Form and Instruction	Modified	Application Guidance and Forms
196036	The Verification of Acceptance or Decline of Award form	Form	New	The Verification of Acceptance or Decline of Award form
196035	Certification Of Accreditation Status for School of Nursing Education Programs Form	Form	New	Certification Of Accreditation Status for School of Nursing Education Programs Form
196034	Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form	Form	New	Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form
196033	Authorization to Release Information Form	Form	New	Authorization to Release Information Form
196032	Employment Verification for Nurse Faculty Appointment Form	Form	New	Employment Verification for Nurse Faculty Appointment Form
182803	Participant Semi-Annual Employment Verification Form	Form	Modified	Emp Verification Form
182802	Pre-Award Script	Form	Removed	Pre-Award Script
182801	Application Checklist and Self-Certification Form	Form	Modified	Application Checklist and Self-Verification Form
182800	Authorization for Release of Employment Information Form	Form	Modified	Authorization for Release of Employment Information Form
182799	Employment Verification and Critical Shortage Facility Form	Form	Modified	Employment Verification and Critical Shortage Facility Form
182798	Loan Information and Verification Form	Form	Modified	Loan Information and Verification Form

ICR Details

OMB Control No: 0915-0140	ICR Reference No: 201101-0915-001
Status: Historical Active	Previous ICR Reference No: 200902-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The Nursing Education Loan Repayment Program
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: 04/25/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/25/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved	04/30/2011
Responses	78,300	0	51,952
Time Burden (Hours)	48,925	0	40,528
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: None

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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:
	75 FR 59720	09/28/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 81623	12/28/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
Application Checklist and Self-Certification Form	NELRP_006	Application Checklist and Self-Verification Form
Authorization for Release of Employment Information Form	NELRP_006	Authorization for Release of Employment Information Form
Authorization to Release Information Form	NELRP_008	Authorization to Release Information Form
Certification Of Accreditation Status for School of Nursing Education Programs Form	NELRP_010	Certification Of Accreditation Status for School of Nursing Education Programs Form
Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form	NELRP_009	Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form
Employment Verification and Critical Shortage Facility Form	NELRP_003	Employment Verification and Critical Shortage Facility Form
Employment Verification for Nurse Faculty Appointment Form	NELRP_004	Employment Verification for Nurse Faculty Appointment Form
Loan Information and Verification Form	NELRP_2	Loan Information and Verification Form
Participant Semi-Annual Employment Verification Form	7	Emp Verification Form
Pre-Award Script	6	Pre-Award Script
The Nursing Education Loan Repayment Program Application	NELRP_001	Application Guidance and Forms
The Verification of Acceptance or Decline of Award form	NELRP_11	The Verification of Acceptance or Decline of Award 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	78,300	51,952	0	-816	27,164	0
Annual Time Burden (Hours)	48,925	40,528	0	-204	8,601	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: Currently, there are 29,800 burden hours in the OMB Inventory. The new request is for 48,925 hours, an increase of 19,125 hours. There is a substantial increase in burden resulting from a program change that increased the budget and a subsequent increase in interest and application to the program. The budget increase is expected to result in a significant increase in the number of applicants to program, from an estimated 5,000 respondents up to 8,000 respondents, an increase of 3,000 respondents.

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Annual Cost to Federal Government: $1,403,633

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 01/25/2011

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