Information Collection

Faculty Loan Repayment Program Application

IC 6381 under ICR 201508-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment B - FLRP Application User Guide.pdf	Instruction
Attachment C - FLRP Application Program Guidance.pdf	Instruction
1 Authorization to Release Information Form Attachment D - Authorization to Release Information Form.pdf	Form and Instruction
2 Institution Loan Repayment Form Attachment E - Institution Loan Repayment Form.pdf	Form and Instruction
3 FLRP Contract Form Attachment F - FLRP Contract Form.pdf	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment B - FLRP Application User Guide.pdf	Yes	No	Printable Only
Instruction			Attachment C - FLRP Application Program Guidance.pdf	Yes	No	Printable Only
Form and Instruction	1	Authorization to Release Information Form	Attachment D - Authorization to Release Information Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Institution Loan Repayment Form	Attachment E - Institution Loan Repayment Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	FLRP Contract Form	Attachment F - FLRP Contract Form.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 222

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	222	-690	912
Annual IC Time Burden (Hours)	250	-434	684
Annual IC Cost Burden (Dollars)	0	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.