REVISED FINAL FLRP Supporting Statement

Supporting Statement

Faculty Loan Repayment Program (FLRP) Application

OMB Control No. 0915-0150

Terms of Clearance: Extension

A. Justification

1. Circumstances of Making the Collection of Information Necessary

This is a request for extension of the Office of Management and Budget (OMB) approval of the information collection requirements and application form for the FLRP currently approved under OMB No. 0915-0150, which expires September 30, 2018. Responsibility for the FLRP program resides in the Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS).

The FLRP is governed by section 738(a) of the Public Health Service Act (42 U.S.C. 293b), as amended by the Health Professions Education Partnerships Act of 1998 (Pub. L.105-392). The purpose of the FLRP is to recruit individuals from an economically and environmentally disadvantaged background who have a health professions degree or certificate to serve as faculty members in eligible, accredited health professions schools by offering to make payments on qualifying education loan(s). The FLRP is administered to those individuals available to serve as full-time or part-time faculty members.

In exchange, the health professional agrees to have an employment commitment with an eligible health professions school to serve as a full-time or part-time faculty member for a minimum of 2 years. Loan repayment agreements are approved by the Secretary for eligible undergraduate and graduate health professional educational loans incurred with government or commercial lending institutions.

All FLRP application information and forms are electronic and are used to determine the applicants’ eligibility and the verification of existing undergraduate and/or graduate health professional educational loans.

This collection of information is necessary to enable HRSA to respond to The President's

Management Agenda, which calls for government reform that is citizen-centric, results-oriented and market-based and requires agencies to participate in e-Government initiatives that provide high quality customer service, provide citizens with readier access to government services, increase access for persons with disabilities to agency Websites and make government more transparent and accountable (http://www.whitehouse.gov/omb/budget/fy2002/mgmt.pdf).

2. Purpose and Use of Information

The applicant completes and submits an electronic application that identifies for the Secretary that the applicant is a disadvantaged health professional who has a contract with an eligible health professions school to serve as a full-time or part-time faculty member for a minimum of 2 years and has qualifying outstanding educational loans. In addition, for each undergraduate and/or graduate loan for which repayment is sought, the applicant is required to submit loan documentation verifying the establishment of the educational loan(s) and lender account statements, promissory notes including the original date, and current balance of the outstanding educational loan(s). After a thorough review of all applications, participants are selected.

The information is needed in order to determine that applicants are in compliance with requirements of the FLRP contract and that the evidence submitted is satisfactory to the

Secretary before entering into an agreement for repayment of undergraduate and/or graduate health professions loans.

The terms and conditions for participating in the FLRP are set forth in the contract between theindividual and the Secretary. In addition, the contract includes the relevant statute authorizing the administration of the FLRP.

3. Use of Improved Information Technology

Currently all FLRP materials are available on the Internet. FLRP application and program guidance and application materials have been integrated into a website for easier access by the public. Program staff members are available to answer inquiries via telephone and e-mail. The website provides the purpose and goal of the program. The program overview, eligibility and employer requirements are featured as well as Frequently Asked Questions. The FLRP materials are easily accessible 24-hours a day. During the application cycle, the application can also be accessed from the website listed below.

FLRP Website: https://bhw.hrsa.gov/loansscholarships/flrp

4. Efforts to Identify Duplication

The information requested in the application is specific to the applicant and unique to the

FLRP.

5. Impact of Small Businesses or Other Small Entities

No small businesses will be involved in this study.

6. Consequences of Collecting the Information Less Frequently

The FLRP requests the information once from each applicant. Without this information, the

program would be unable to determine the applicant’s eligibility. There are no legal obstacles to reduce the burden.

7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5(d)(2)

This request fully complies with the regulation.

8. Comments in Response to the Federal Register Notice/Outside Consultation

A 60-day Federal Register Notice was published in the Federal Register on March 6, 2018, Vol. 83, No. 44; p.9522. There were no public comments.

Section 8B:

The individuals listed below were contacted in 2018 to verify the burden associated with the FLRP application. The applicants reported no particular difficulty in completing the form, and no change in the estimated burden for completing the form. One individual acknowledged that the site was user-friendly and that the process was easy to follow.

Yusuf Ransome

170 Brookline Avenue
Unit 816
Boston, MA 02215 United

9174465477

[email protected]

Talia Sierra

2922 S. Andros Way
Meridian, ID 83642

2086315593

[email protected]

9. Explanation of Any Payment/Gift to Respondents

Respondents will not receive any payments or gifts.

10. Assurance of Confidentiality Provided to Respondents

Data will be kept private to the extent allowed by law. The Right to Financial Privacy Act (RFPA), Pub. L. 95-630, regulates any financial institution that provides a Federal agency with access to information contained in the financial records of a customer. Section 1102(a) prohibits government access to financial records unless one of five procedures is used and the records are "reasonably described." The procedure being used by FLRP requires the applicant to submit loan documentation that verifies the establishment of the loan(s) and lender statement(s), which identifies the current loan balance(s), verifies the applicant’s address and provides the applicant’s Social Security Number. All applicants must comply with this requirement.

A Privacy Act Notification Statement is included on the FLRP website which describes the

purposes of the information collection and the potential disclosures. A Privacy Act System of

Records, #09-15-0058, has been established for the FLRP, HHS/HRSA/BHW.

11. Justification for Sensitive Questions

Questions regarding race and ethnicity are asked in the online application; however, responses to these questions are optional. The disclosure of the applicant's Social Security Number (SSN) is required by section 4 of the Debt Collection Act of 1982 (26 U.S.C. 6103) and the applicant provides this information on the lender statement(s). The disclosure of the Social Security Number is required for participation in the program, since the amounts repaid to lenders must be reported to the Internal Revenue Service as "other income" on IRS Form 1099. Safeguards are followed concerning the use of the SSN in the Privacy Act of 1974 (5 U.S.C. 552a note).

12. A. Estimates of Annualized Burden Hours

Type of Respondent	Form Name	No. of Respondents	No. Responses per Respondent	Total Responses	Average Burden per Response (in hours)	Total Burden Hours
Applicant	Eligible Application	111	1	111	1	111
Applicant	Authorization to Release Information Form	111	1	111	.25	27.75
Institution	Loan Repayment Employment Form	111*	1	111	1	111
Total		222		222		249.75

*Respondent for this form is the institution for the applicant.

Burden estimates were derived from information provided by applicants and institutions completing the required application package and forms. The application and employment forms require 1 hour each to complete. Authorization to Release Information required 15 minutes to complete or .25 hour. The hour-burden estimates include the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

12. B. Estimated Annualized Burden Costs

Type of Respondent	Total Burden Hours	Hourly Wage Rate**	Total Respondent Costs
***Mid-level administrator	24	$43	$1,032
Mid-level Health Care Professional	43	$43	$1,849
Total	67		$2,881

*The Mid-level Health Care Professional total burden hours is totals 43 since the same respondent is completing the online application and the authorization to release forms.

***Respondent for this form is the institution for the applicant.

** Based on the following: http://www.bls.gov/oes/current/oessrci.htm#62

13. Estimates of other Total Annual Cost Burden to Respondents or Record Keepers/Capital Costs

Other than their time, there is no cost to respondents.

14. Estimates of Annualized Estimates of Annualized Cost to the Government

Instrument	Base Pay Rate	Project Time per FTE	Number of FTEs	Total Annual Cost
FLRP	$89,703/GS-12 Step 4	.15	10	$134,554.50
FLRP Online Application Contract	$ 58,917.28	……..	…………	$ 58,917.28
Total	……….	………	………..	$193,471.78

Base Pay Rate based on the Office of Personnel Management Pay Scale: (https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2018/DCB.pdf)

The annual cost to the government is approximately $58,917.28 for the contract costs for the online application system and $134,554.50 for 10 GS-12 Step 4 employees at a .15 FTE rate to process the applications and facilitate team members in the loan repayment process.

15. Explanation for Program Changes or Adjustments

The estimated total burden for this activity is 250 hours resulting in no change from the current burden hour inventory.

16. Plans for Tabulation, Publication, and Project Time Schedule

There are no plans for the tabulation, statistical analysis or publication of the information.

17. Reason(s) Display of OMB Expiration Date is Inappropriate

The OMB number and expiration date will be displayed on every page of every form/instrument.

18. Exceptions to Certification for Paperwork Reduction Act Submissions

This project fully complies with the guidelines set forth in 5 CFR 1320.9. The required certifications are included in this package.

List of Instruments

FLRP Online Application User Guide

Authorization to Release Information Form

Institution Employment/Loan Repayment Verification Form

List of Attachments

Attachment A: Authorizing Legislation and Regulations

Attachment B: Application and Program Guidance

Attachment C: FLRP Contract Form