The Nursing Education Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Application	Form and Instruction	Modified	Available
Form NELRP_11 The Verification of Acceptance or Decline of Award form	Form	Removed	Available
Form NELRP_010 Certification Of Accreditation Status for School of Nursing Education Programs Form	Form	Removed	Available
Form NELRP_009 Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form	Form	Removed	Available
Form 1 Authorization to Release Information Form	Form	Modified	Available
Form NELRP_004 Employment Verification for Nurse Faculty Appointment Form	Form	Removed	Available
Form 4 ISV	Form and Instruction	Modified	Available
Form NELRP_006 Application Checklist and Self-Verification Form	Form	Removed	Available
Form 2 Authorization to Release Employment Information Form	Form	Modified	Available
Form NELRP_003 Employment Verification and Critical Shortage Facility Form	Form	Removed	Available
Form NELRP_2 Loan Information and Verification Form	Form	Removed	Available
Supporting Statement.doc	Supporting Statement A	Uploaded 2014-04-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6368	The Nursing Education Loan Repayment Program Application	Form and Instruction	Modified	Application
196036	The Verification of Acceptance or Decline of Award form	Form	Removed	The Verification of Acceptance or Decline of Award form
196035	Certification Of Accreditation Status for School of Nursing Education Programs Form	Form	Removed	Certification Of Accreditation Status for School of Nursing Education Programs Form
196034	Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form	Form	Removed	Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form
196033	Authorization to Release Information Form	Instruction	Modified
196033	Authorization to Release Information Form	Form	Modified	Authorization to Release Information Form
196032	Employment Verification for Nurse Faculty Appointment Form	Form	Removed	Employment Verification for Nurse Faculty Appointment Form
182803	Participant Semi-Annual Employment Verification Form	Form and Instruction	Modified	ISV
182801	Application Checklist and Self-Certification Form	Form	Removed	Application Checklist and Self-Verification Form
182800	Authorization for Release of Employment Information Form	Form	Modified	Authorization to Release Employment Information Form
182799	Employment Verification and Critical Shortage Facility Form	Form	Removed	Employment Verification and Critical Shortage Facility Form
182798	Loan Information and Verification Form	Form	Removed	Loan Information and Verification Form

ICR Details

OMB Control No: 0915-0140	ICR Reference No: 201403-0915-003
Status: Historical Active	Previous ICR Reference No: 201101-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No: 21547
Title: The Nursing Education Loan Repayment Program
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: 04/21/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/17/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved	04/30/2014
Responses	21,100	0	78,300
Time Burden (Hours)	14,400	0	48,925
Cost Burden (Dollars)	4,125	0	0

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Abstract: Approval is requested for the application and monitoring forms for the Nursing Education Loan Repayment Program (NELRP). Under the NELRP, registered nurses are offered the opportunity to enter into a contractual agreement to receive loan repayment for some of their qualifying education loan balances. This repayment is in exchange for agreeing to servie full-time as a registered nurse for 2-3 years at a health care facilitiy with a critical shortage of nurses.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 VIII Name of Law: American Recovery and Reinvestment Act
   US Code: 42 USC 297n Name of Law: Public Health Service Act
  

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:
	78 FR 77136	12/20/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 11799	03/03/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Application Checklist and Self-Certification Form	NELRP_006	Application Checklist and Self-Verification Form
Authorization for Release of Employment Information Form	2	Authorization to Release Employment Information Form
Authorization to Release Information Form	1	Authorization to Release Information Form
Certification Of Accreditation Status for School of Nursing Education Programs Form	NELRP_010	Certification Of Accreditation Status for School of Nursing Education Programs Form
Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form	NELRP_009	Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form
Employment Verification and Critical Shortage Facility Form	NELRP_003	Employment Verification and Critical Shortage Facility Form
Employment Verification for Nurse Faculty Appointment Form	NELRP_004	Employment Verification for Nurse Faculty Appointment Form
Loan Information and Verification Form	NELRP_2	Loan Information and Verification Form
Participant Semi-Annual Employment Verification Form	4	ISV
The Nursing Education Loan Repayment Program Application	3	Application
The Verification of Acceptance or Decline of Award form	NELRP_11	The Verification of Acceptance or Decline of Award 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	21,100	78,300	0	-57,200	0	0
Annual Time Burden (Hours)	14,400	48,925	0	-34,525	0	0
Annual Cost Burden (Dollars)	4,125	0	0	4,125	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: Currently, there are 48,925 burden hours in the OMB Inventory. The new request is for 14,400 hours, a decrease of 34,525 hours. This substantial decrease in burden accounts for the streamlined application. The current online application incorporates a majority of the supporting and supplemental documents, thereby significantly reducing the number of burden hours spent by respondents.

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Annual Cost to Federal Government: $970,464

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: 03/17/2014

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