National Institutes of Health Loan Repayment Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Applicant Forms	Form	Unchanged	Available
Form 1 ACH Vendor Payment Form	Form and Instruction	Unchanged	Available
Form 1 ACH Vendor Payment Form	Form and Instruction	Unchanged	Available
Form 3 Recommenders	Form	Unchanged	Available
Form 2 Advisors or Supervisors	Form	Unchanged	Available
Form 1 Applicant Forms	Form	Unchanged	Available
Form 2 Advisors or Supervisors	Form	Unchanged	Available
Form 1 Applicant Forms	Form	Unchanged	Available
Form 3 Recommenders	Form	Unchanged	Available
Form 2 Advisors or Supervisors	Form	Unchanged	Available
Form 1 Applicant Forms	Form	Unchanged	Available
Form 3 Recommenders	Form	Unchanged	Available
Form 2 Advisors or Supervisors	Form	Unchanged	Available
Eligibilty - HD with burden statement.pdf	Supplementary Document	Uploaded 2019-08-06	Available
Change Request Memo - LRP 08-06-2019 (1).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2019-08-06	Available
Applicants - Colleagues Info Tab - June 2018.pdf	Supplementary Document	Uploaded 2018-06-28	Available
OMB Change Request Memo - LRP 06-25-2018.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2018-06-28	Available
Mentor.pdf	Supplementary Document	Uploaded 2017-06-29	Available
Referee.pdf	Supplementary Document	Uploaded 2017-06-29	Available
Applicant.pdf	Supplementary Document	Uploaded 2017-06-29	Available
OMB Change Request Memo - LRP 06-27-2017.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2017-06-29	Available
Final SSA Loan Repayment Supporting_Statementdocx.docx	Supporting Statement A	Uploaded 2016-08-26	Available
Privacy Impact Assessment-NIH OD LRP Website System (2012).pdf	Supplementary Document	Uploaded 2016-07-15	Available
OAS Instructions Final 07142016.pdf	Supplementary Document	Uploaded 2016-07-15	Available
LRP 30-day notice.pdf	Supplementary Document	Uploaded 2016-07-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7282	Intramural/InitialApplications	Form	Unchanged	Applicant Forms
222491	Extramural/ Financial Institutions	Form and Instruction	Unchanged	ACH Vendor Payment Form
222490	Intramural/ Financial Institutions	Form and Instruction	Unchanged	ACH Vendor Payment Form
184374	Extramural/ Recommenders and Institution Contacts	Form	Unchanged	Recommenders
184373	Extramural/ Advisors and Supervisors	Form	Unchanged	Advisors or Supervisors
184372	Extramural/ Renewal Applicants	Form	Unchanged	Applicant Forms
184371	Intramural/ Advisors and Supervisors	Form	Unchanged	Advisors or Supervisors
184370	Intramural/ Renewal Applications	Form	Unchanged	Applicant Forms
184368	Extramural/ Recommenders and Institution Contacts	Form	Unchanged	Recommenders
184367	Extramural/ Advisors and Supervisors	Form	Unchanged	Advisors or Supervisors
184366	Extramural/ Initial Applicants	Form	Unchanged	Applicant Forms
184364	Intramural/Recommenders and Institution Contacts	Form	Unchanged	Recommenders
184363	Intramural/Advisors and Supervisors	Form	Unchanged	Advisors or Supervisors

ICR Details

OMB Control No: 0925-0361	ICR Reference No: 201908-0925-002
Status: Historical Active	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: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/14/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/06/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	08/31/2019	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 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). There are a total of 3 Intramural and 5 Extramural programs. Intramural includes AIDS Research Loan Repayment Program (AIDS-LRP), the General Research LRP (GR-LRP), which includes a program for the Accreditation Council for Graduate Medical Education (ACGME) Fellows, and the Clinical Research LRP for Individuals from Disadvantaged Backgrounds (CR-LRP). The Extramural programs include Clinical Research LRP for Individuals from Disadvantaged Backgrounds (ECR-LRP), the Pediatric Research LRP (PR-LRP), the Contraception and Infertility Research LRP (CIR-LRP), the Health Disparities Research LRP (HD-LRP), and the Clinical Research LRP (LRP-CR). Data collected through application forms is necessary to determine an applicant's eligibility for the program, including his or her research plans and career interests. The forms presented to the applicant vary based on the application type, Initial/New or Renewal. Each initial applicant is expected to spend approximately 11 hours completing and assembling the application package, and each renewal applicant approximately 7 hours. Both applications require supporting online forms to be completed by their colleagues.

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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:
	81 FR 8514	02/19/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 44642	07/08/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Extramural/ Advisors and Supervisors	2	Advisors or Supervisors
Extramural/ Advisors and Supervisors	2	Advisors or Supervisors
Extramural/ Financial Institutions	1	ACH Vendor Payment Form
Extramural/ Initial Applicants	1	Applicant Forms
Extramural/ Recommenders and Institution Contacts	3	Recommenders
Extramural/ Recommenders and Institution Contacts	3	Recommenders
Extramural/ Renewal Applicants	1	Applicant Forms
Intramural/ Advisors and Supervisors	2	Advisors or Supervisors
Intramural/ Financial Institutions	1	ACH Vendor Payment Form
Intramural/ Renewal Applications	1	Applicant Forms
Intramural/Advisors and Supervisors	2	Advisors or Supervisors
Intramural/InitialApplications	1	Applicant Forms
Intramural/Recommenders and Institution Contacts	3	Recommenders

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	13,218	13,218	0	0	0	0
Annual Time Burden (Hours)	33,242	33,242	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Since receiving approval for the online application forms in 2014, the Division of Loan Repayment had a slight decline in the number of applications received each cycle. Questions, required information, and requested documents remain largely unchanged. Improvements were made to the structure and appearance of online forms to provide applicants with a better user experience. Information collected from the Applicant Information form (NIH 2674-1) will now be spread over three online sections (tabs) for an improved user experience. Recommenders will no longer be asked to complete a recommendation form (NIH 2674-13), but to write a reference letter that comments on the research skills and the abilities of the applicant. A general eligibility checklist (NIH 2674-20) was added to the start of the application to reduce the probability of ineligible individuals working through the application only to learn of their disqualification after submitting the application. Several existing forms were strategically grouped under different online screens (tabs) within the application to provide applicants with a better flow as they work through their applications. Redundant questions or statements were eliminated.

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Annual Cost to Federal Government: $1,659,000

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: 08/06/2019

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