Faculty Loan Repayment Program Application

ICR 201508-0915-001

OMB: 0915-0150

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2015-09-21
Supplementary Document
2015-09-21
Supplementary Document
2015-08-03
Supporting Statement A
2015-09-22
IC Document Collections
IC ID
Document
Title
Status
6381 Modified
ICR Details
0915-0150 201508-0915-001
Historical Active 201208-0915-002
HHS/HSA
Faculty Loan Repayment Program Application
Revision of a currently approved collection   No
Regular
Approved without change 09/30/2015
Retrieve Notice of Action (NOA) 08/04/2015
  Inventory as of this Action Requested Previously Approved
09/30/2018 36 Months From Approved 10/31/2015
222 0 912
250 0 684
0 0 0

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. All FLRP application information is electronic and is essential to determine the applicants' eligibility and the creditability of existing undergraduate and/or graduate health professional educational loans. The respondents are full-time or part-time faculty members and administrators at schools of health professions.

PL: Pub.L. 105 - 392 738(a) Name of Law: Health Professions Education Partnerships Act of 1998
   US Code: 42 USC 293b Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  80 FR 63 04/02/2015
80 FR 140 07/22/2015
No

1
IC Title Form No. Form Name
Faculty Loan Repayment Program Application 1, 2, 3 Authorization to Release Information Form ,   Institution Loan Repayment Form ,   FLRP Contract Form

  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 222 912 0 -690 0 0
Annual Time Burden (Hours) 250 684 0 -434 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Using Information Technology
The total burden hours for this activity are 250 hours. This is a decrease from the previously approved annual burden of 684 hours. This decrease is due to a program adjustment and minor change in the electronic application format, which incorporated a majority of the required supporting, screened for ineligible or incomplete applications and supplemental documents as part of the electronic submission of the application.

$184,943
No
No
No
No
No
Uncollected
Lisa Wright-Solomon 3014430985

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/04/2015


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