Faculty Loan Repayment Program Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Faculty Loan Repayment Program Application	Form and Instruction	Modified	Available
Form 004_FLRP FLRP Online Banking Form	Form	Removed	Available
Form 004_FLRP Loan Information and Verification Form	Form	Removed	Available
Form 003_FLRP FLRP Institution Employment-Loan Repayment Form	Form	Removed	Available
Form 002-FLRP FLRP Checklist	Form	Removed	Available
Application and Program Guidance.docm	Supplementary Document	Uploaded 2012-08-01	Available
Supporting Statement.doc	Supporting Statement A	Uploaded 2012-08-01	Source copy available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified
189999	FLRP Online Banking Form	Form	Removed
189998	Loan Information and Verification Form	Form	Removed
189997	FLRP Institution Employment-Loan Repayment Form	Form	Removed
189996	FLRP Checklist	Form	Removed

ICR Details

OMB Control No: 0915-0150	ICR Reference No: 201208-0915-002
Status: Historical Active	Previous ICR Reference No: 200907-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Faculty 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 without change	Conclusion Date: 10/12/2012
	Date Received in OIRA: 08/07/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2015	36 Months From Approved	10/31/2012
Responses	912	0	905
Time Burden (Hours)	684	0	1,087
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the Faculty Loan Repayment Program is to attract disadvantaged health professionals into faculty positions in accredited health professions schools by offering to make partial payments on education loans. In exchange, the graduate health professional agrees to have a contract with an accredited health professions school to serve as a faculty member for a minimum of two years.

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Authorizing Statute(s): US Code: 42 USC 293b Name of Law: Public Health Service Act
   PL: Pub.L. 105 - 392 738(a) Name of Law: Health Professions Education Partnerships Act of 1998
  

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:
	77 FR 28607	05/15/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 42748	07/20/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Faculty Loan Repayment Program Application	1, 2	Online Application ,   FLRP Forms
FLRP Checklist	002-FLRP	002-FLRP
FLRP Institution Employment-Loan Repayment Form	003_FLRP	FLRP_Inst Empl Repayment Form
Loan Information and Verification Form	004_FLRP	Loan Information and Verification Form
FLRP Online Banking Form	004_FLRP	Online Banking 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	912	905	0	7	0	0
Annual Time Burden (Hours)	684	1,087	0	-403	0	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: This decrease is due to a program adjustment and minor change in the electronic application format, which incorporated a majority of the required supporting and supplemental documents as part of the electronic submission of the application.

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Annual Cost to Federal Government: $105,211

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: 08/07/2012

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