Information Collection

LRP Ambassador Sign-up and Consent

IC 222744 under ICR 201602-0925-001 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 LRP Ambassador Sign-up and Consent	Form
1 LRP Ambassador Sign-up Form LRP Ambassador Sign-up Form 7-28-16.docx	Form
LRP Ambassador OMB Clearance Form 7-28-16.doc LRP Ambassador OMB Clearance Form	IC Document

IC Title:

LRP Ambassador Sign-up and Consent

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	LRP Ambassador Sign-up Form	LRP Ambassador Sign-up Form 7-28-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: National Institutes of Health (NIH) Office of Loan Repayment and Scholarship (OLRS) Record System, HHS/NIH/OD.

FR Citation: 67 FR 6043

Number of Respondents: 1,500

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
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
LRP Ambassador OMB Clearance Form	LRP Ambassador OMB Clearance Form 7-28-16.doc	07/28/2016

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