Information Collection

Faculty Loan Repayment Program Application

IC 6381 under ICR 201806-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
FLRP Application User Guide.pdf	Instruction
2 Authorization to Release Information Form.docx Authorization to Release Information Form.docx	Form and Instruction
3 Institution Loan Repayment Form.docx Institution Loan Repayment Form.docx	Form and Instruction
Attachment A - FLRP Authorizing Legislation.docx Attachment A: Authorizing Legislation and Regulations	IC Document
Attachment B - Application and Program Guidance.pdf Attachment B: Application and Program Guidance	IC Document
Attachment C - FLRP Contract.pdf Attachment C: FLRP Contract Form	IC Document

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			FLRP Application User Guide.pdf	Yes	No	Printable Only
Form and Instruction	2	Authorization to Release Information Form.docx	Authorization to Release Information Form.docx	Yes	No	Fillable Printable
Form and Instruction	3	Institution Loan Repayment Form.docx	Institution Loan Repayment Form.docx	Yes	No	Fillable Printable

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	Previously Approved
Annual Number of Responses for this IC	222	222
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A: Authorizing Legislation and Regulations	Attachment A - FLRP Authorizing Legislation.docx	06/14/2018
Attachment B: Application and Program Guidance	Attachment B - Application and Program Guidance.pdf	06/14/2018
Attachment C: FLRP Contract Form	Attachment C - FLRP Contract.pdf	06/14/2018

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