Information Collection

Faculty Loan Repayment Program Application

IC 6381 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 Faculty Loan Repayment Program Application Form and Instruction
1 Online Application FLRP Online Application User Guide.pdf Form and Instruction
2 FLRP Forms FLRP Forms Package 2012_Final_04032012.doc Form and Instruction
Application and Program Guidance.docm Application and Program Guidance IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Faculty Loan Repayment Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Online Application	FLRP Online Application User Guide.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	FLRP Forms	FLRP Forms Package 2012_Final_04032012.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 304	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	912	731	181
Annual IC Time Burden (Hours)	684	503	181
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Application and Program Guidance	Application and Program Guidance.docm	08/01/2012

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