National Institutes of Health Loan Repayment Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Intramural/InitialApplications	Form	Removed	Repair queued
Form 4 NIH LRP Coordinators	Form and Instruction	New	Available
Form 3 Institutional Business Officers (IBO)	Form and Instruction	New	Repair queued
Form 2 Recommenders	Form and Instruction	New	Repair queued
Form 1 Renewal Intramural Applicants	Form and Instruction	New	Available
Form 1 Initial Intramural Applicants	Form and Instruction	New	Available
Form 1 Renewal Extramural Applicants	Form and Instruction	New	Available
Form 1 Initial Extramural Applicants	Form and Instruction	New	Repair queued
Form 1 Extramural/ Financial Institutions	Form and Instruction	Removed	Available
Form 1 Intramural/ Financial Institutions	Form and Instruction	Removed	Repair queued
Form 3 Extramural/ Recommenders and Institution Contacts	Form	Removed	Repair queued
Form 2 Extramural/ Advisors and Supervisors	Form	Removed	Repair queued
Form 1 Extramural/ Renewal Applicants	Form	Removed	Repair queued
Form 2 Intramural/ Advisors and Supervisors	Form	Removed	Available
Form 1 Intramural/ Renewal Applications	Form	Removed	Available
Form 3 Extramural/ Recommenders and Institution Contacts	Form	Removed	Repair queued
Form 2 Extramural/ Advisors and Supervisors	Form	Removed	Available
Form 1 Extramural/ Initial Applicants	Form	Removed	Available
Form 3 Intramural/Recommenders and Institution Contacts	Form	Removed	Available
Form 2 Intramural/Advisors and Supervisors	Form	Removed	Available
pub 30day FRN 2019-16288.pdf	Supplementary Document	Uploaded 2019-07-31	Repair queued
Attachment 1 HHS Approved - LRP Privacy Impact Assessment 2018.11.30.pdf	Supplementary Document	Uploaded 2019-07-19	Repair queued
Loan Repayment Supporting Statement A_07_16_2019.docx	Supporting Statement A	Uploaded 2019-07-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7282	Intramural/InitialApplications	Form	Removed
237011	NIH LRP Coordinators	Form and Instruction	New
237009	Institutional Business Officers (IBO)	Form and Instruction	New
237005	Recommenders	Form and Instruction	New
237004	Renewal Intramural Applicants	Form and Instruction	New
237002	Initial Intramural Applicants	Form and Instruction	New
237000	Renewal Extramural Applicants	Form and Instruction	New
236998	Initial Extramural Applicants	Form and Instruction	New
222491	Extramural/ Financial Institutions	Form and Instruction	Removed
222490	Intramural/ Financial Institutions	Form and Instruction	Removed
184374	Extramural/ Recommenders and Institution Contacts	Form	Removed
184373	Extramural/ Advisors and Supervisors	Form	Removed
184372	Extramural/ Renewal Applicants	Form	Removed
184371	Intramural/ Advisors and Supervisors	Form	Removed
184370	Intramural/ Renewal Applications	Form	Removed
184368	Extramural/ Recommenders and Institution Contacts	Form	Removed
184367	Extramural/ Advisors and Supervisors	Form	Removed
184366	Extramural/ Initial Applicants	Form	Removed
184364	Intramural/Recommenders and Institution Contacts	Form	Removed
184363	Intramural/Advisors and Supervisors	Form	Removed

ICR Details

OMB Control No: 0925-0361	ICR Reference No: 201907-0925-005
Status: Historical Inactive	Previous ICR Reference No: 201806-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: National Institutes of Health Loan Repayment Programs
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 08/06/2019
	Date Received in OIRA: 07/31/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2019
Responses	13,218	0	13,218
Time Burden (Hours)	33,242	0	33,242
Cost Burden (Dollars)	0	0	0

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Abstract: The NIH Loan Repayment Programs (LRPs) are designed to attract highly qualified physicians and other scientific or medical personnel to research opportunities at the National Institutes of Health (NIH, Intramural) and non-NIH sites (Extramural). Data collected through application forms is necessary to determine an applicant’s eligibility for the program, including the applicant’s research plans and career interests.

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Authorizing Statute(s): US Code: 42 USC 288-1 Name of Law: AIDS Research loan Repayment Program
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 23060	05/21/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 37326	07/31/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Intramural/InitialApplications	1	Applicant Forms
Intramural/Recommenders and Institution Contacts	3	Recommenders
Extramural/ Renewal Applicants	1	Applicant Forms
Institutional Business Officers (IBO)	3	Institutional Business Officer (IBO)
NIH LRP Coordinators	4	NIH LRP Coordinator
Renewal Extramural Applicants	1	Applicant
Intramural/Advisors and Supervisors	2	Advisors or Supervisors
Extramural/ Recommenders and Institution Contacts	3	Recommenders
Intramural/ Renewal Applications	1	Applicant Forms
Intramural/ Advisors and Supervisors	2	Advisors or Supervisors
Extramural/ Advisors and Supervisors	2	Advisors or Supervisors
Extramural/ Financial Institutions	1	ACH Vendor Payment Form
Initial Extramural Applicants	1	Applicant
Extramural/ Initial Applicants	1	Applicant Forms
Extramural/ Advisors and Supervisors	2	Advisors or Supervisors
Extramural/ Recommenders and Institution Contacts	3	Recommenders
Intramural/ Financial Institutions	1	ACH Vendor Payment Form
Initial Intramural Applicants	1	Applicant
Renewal Intramural Applicants	1	Applicant
Recommenders	2	Recommender

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Extension there are no changes to collection

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Annual Cost to Federal Government: $1,720,394

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/31/2019

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