Veterinary Medicine Loan Repayment Program Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NIFA-0004 Loan Information	Form	Unchanged	Repair queued
Form NIFA-0004 Loan Information	Form	Unchanged	Repair queued
Form NIFA-09-10 Service Verification	Form	Unchanged	Available
Form NIFA-08-10 Recommendation Form	Form	Unchanged	Available
Form NIFA-07-10 Intent of Employment	Form	Unchanged	Available
Form NIFA-06-10 Certifications for Application	Form	Unchanged	Available
Form NIFA-05-10 Veterinary Medicine Loan Repayment Program Contract	Form	Unchanged	Available
Form NIFA-03-10 List of Recommenders	Form	Unchanged	Available
Form NIFA-02-10 Personal Statement	Form	Unchanged	Available
Form NIFA-01-10 Applicant Information	Form	Unchanged	Available
VMLRP_Program_Supporting_Statement_Final[1][2].docx	Supporting Statement A	Uploaded 2011-09-28	Available
vmlrp_comments_response[1].docx	Supplementary Document	Uploaded 2010-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191733	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Loan Information
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Loan Information
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Service Verification
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Recommendation Form
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Intent of Employment
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Certifications for Application
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Veterinary Medicine Loan Repayment Program Contract
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	List of Recommenders
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Personal Statement
191731	Veterinary Medicine Loan Repayment Program Application	Form	Unchanged	Applicant Information

ICR Details

OMB Control No: 0524-0047	ICR Reference No: 201105-0524-001
Status: Historical Active	Previous ICR Reference No: 201011-0524-001
Agency/Subagency: USDA/NIFA	Agency Tracking No:
Title: Veterinary Medicine 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 with change	Conclusion Date: 10/12/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/27/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved	10/31/2011
Responses	2,600	0	600
Time Burden (Hours)	2,820	0	1,350
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection allows the National Institute of Food and Agriculture (NIFA) to request from Veterinary Medicine Loan Repayment Program applicants information related to eligibility, qualifications, career interests, and recommendations necessary to evaluate their applications for repayment of educational indebtedness in return for agreeing to provide veterinary services in veterinarian shortage situations.

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Authorizing Statute(s): US Code: 7 USC 3151A Name of Law: National Agricultural Research, Extension, and Teaching Policy Act of 1997
  

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 3193	01/20/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 187	09/28/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Veterinary Medicine Loan Repayment Program Application	NIFA-0004	Loan Information
Veterinary Medicine Loan Repayment Program Application	NIFA-01-10, NIFA-08-10, NIFA-03-10, NIFA-05-10, NIFA-06-10, NIFA-07-10, NIFA-02-10, NIFA-09-10, NIFA-0004	Applicant Information ,   Personal Statement ,   List of Recommenders ,   Veterinary Medicine Loan Repayment Program Contract ,   Certifications for Application ,   Intent of Employment ,   Recommendation Form ,   Service Verification ,   Loan Information

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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	2,600	600	0	240	1,760	0
Annual Time Burden (Hours)	2,820	1,350	0	60	1,410	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 an adjustment increase in the number of respondents, responses and burden hours. The number of applications increased from 100 to 200. The adjustment increase is due to the estimate for applications that were made prior to the inaugural application cycle when there was no base to project the number of applications. The is a program change increase in the number of respondents, responses, and burden of 60 hours due to adding the Service Verification form for award recipients.

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Annual Cost to Federal Government: $91,868

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: 05/27/2011

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