Faculty Loan Repayment Program Application

Faculty Loan Repayment Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0150 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.