Information Collection

IHS Loan Application

IC 6573 under ICR 201205-0917-001 · OMB 0917-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0014 IHS Loan Application	Form
0917-0014 Financial information financial.pdf www.ihs.gov/loanrepayment/lrpOnlineApp/	Form
0917-0014 Education Information education.pdf www.ihs.gov/loanrepayment/lrpOnlineApp/	Form
0917-0014 General Applicant Information general_applicant_info.pdf www.ihs.gov/loanrepayment/lrpOnlineApp/	Form

IC Title:

IHS Loan Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.5(d)(2)

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	0917-0014	Financial information	financial.pdf	https://www.ihs.gov/loanrepayment/lrpOnlineApp/	Yes	Yes	Fillable Fileable
Form	0917-0014	Education Information	education.pdf	https://www.ihs.gov/loanrepayment/lrpOnlineApp/	Yes	Yes	Fillable Fileable
Form	0917-0014	General Applicant Information	general_applicant_info.pdf	https://www.ihs.gov/loanrepayment/lrpOnlineApp/	No	No	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 510

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	510	0	510
Annual IC Time Burden (Hours)	765	612	153
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.