Information Collection

Survey of Loan Repayment Program Participants

IC 205979 under ICR 201103-0925-002 · OMB 0925-0627.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0627 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey of Loan Repayment Program Participants	Form and Instruction
1 DLR Survey Screenshots Attachment 3 - DLR Survey Screenshots_.docx	Form and Instruction
Attachment 1 - First Invitation Email.docx Attachment 1 - First Invitation Email	IC Document
Attachment 2 - Second Invitation Email - Copy.docx Attachment 2 - Second Invitation Email - Copy	IC Document
DLR generic_clearance_form[1].doc DLR generic_clearance_form[1]	IC Document
DLR Survey OMB Cover Submission Memo.doc DLR Survey OMB Cover Submission Memo	IC Document

IC Title:

Survey of Loan Repayment Program Participants

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	DLR Survey Screenshots	Attachment 3 - DLR Survey Screenshots_.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,800	0	0	0	0	0
Annual IC Time Burden (Hours)	600	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1 - First Invitation Email	Attachment 1 - First Invitation Email.docx	02/27/2013
Attachment 2 - Second Invitation Email - Copy	Attachment 2 - Second Invitation Email - Copy.docx	02/27/2013
DLR generic_clearance_form[1]	DLR generic_clearance_form[1].doc	02/27/2013
DLR Survey OMB Cover Submission Memo	DLR Survey OMB Cover Submission Memo.doc	02/27/2013

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