Information Collection

Loan Information and Verification Form

IC 189998 under ICR 201208-0915-002 · OMB 0915-0150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0150 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 004_FLRP Loan Information and Verification Form	Form
004_FLRP Loan Information and Verification Form FLRP_Loan Information and Verification Form.pdf	Form

IC Title:

Loan Information and Verification Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	004_FLRP	Loan Information and Verification Form	FLRP_Loan Information and Verification Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 181

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-181	181
Annual IC Time Burden (Hours)	-543	543
Annual IC Cost Burden (Dollars)	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.