Indian Health Service Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0917-0014 IHS Loan Application	Form and Instruction	Modified	Available
FINAL_LRP_Supporting_Statement_6-22-15 DRA.docx	Supporting Statement A	Uploaded 2015-06-23	Available
60 day FR Publication 04-28-15 (2).pdf	Supplementary Document	Uploaded 2015-06-22	Available
30 Day Federal Register Notice for IHS Loan Repayment Program, June 11, 2015.pdf	Supplementary Document	Uploaded 2015-06-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6573	IHS Loan Application	Form and Instruction	Modified

ICR Details

OMB Control No: 0917-0014	ICR Reference No: 201506-0917-001
Status: Historical Active	Previous ICR Reference No: 201205-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No: 0917-0014
Title: Indian Health Service Loan Repayment Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/28/2015
	Date Received in OIRA: 06/24/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	36 Months From Approved	07/31/2015
Responses	816	0	510
Time Burden (Hours)	1,224	0	765
Cost Burden (Dollars)	0	0	0

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Abstract: The Indian Health Service (IHS) Loan Repayment Program (LRP) identifies health professionals with pre-existing financial obligations for education expenses that meet program criteria and who are qualified and willing to serve at, often remote, IHS health care facilities. Under the program, eligible health professionals sign a contract under which the IHS agrees to repay part or all of their indebtedness for professional training education. In exchange, the health professionals agree to serve for a specified period of time in IHS health care facilities. This information collection covers the application process for this program.

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Authorizing Statute(s): PL: Pub.L. 94 - 437 108 Name of Law: Indian Health Care Improvement Act, as amended
  

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:
	80 FR 23558	04/28/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 33275	06/11/2015
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
IHS Loan Application	0917-0014, 0917-0014, 0917-0028	Educational and Professional Background ,   Financial Information ,   General Applicant Information

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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	816	510	0	0	306	0
Annual Time Burden (Hours)	1,224	765	0	0	459	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: No

Burden Reduction Due to:

Short Statement: This is a request for an extension. There was an adjustment or increase in annual burden hours from the previously approved annual burden hours of 765 to 1224. The increase in annual burden hours of 459 hours is due to an increase in the number of respondents or applicants from 510 to 816 individuals. There was also a small increase in cost to the Federal Government of $98, which reflects an increase in costs related to processing more applications. There were no program changes.

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Annual Cost to Federal Government: $75,348

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: 06/24/2015

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