The National Health Service Corps (NHSC) Loan Repayment Programs

ICR 202004-0915-004

OMB: 0915-0127

Federal Form Document

Forms and Documents
ICR Details
0915-0127 202004-0915-004
Active 202002-0915-002
HHS/HSA 20941
The National Health Service Corps (NHSC) Loan Repayment Programs
No material or nonsubstantive change to a currently approved collection   No
Approved without change 04/23/2020
Retrieve Notice of Action (NOA) 04/21/2020
  Inventory as of this Action Requested Previously Approved
03/31/2023 03/31/2023 03/31/2023
25,933 0 25,933
12,735 0 12,735
0 0 0

The National Health Service Corps (NHSC) Loan Repayment Program (LRP) was established to assure an adequate supply of trained primary care health professionals to provide services in the neediest Health Professional Shortage Areas (HPSAs) of the United States. The NHSC Substance Use Disorder (SUD) Workforce LRP and the Rural Community LRP were established to recruit and retain a health professional workforce with specific training and credentials to provide evidence-based SUD treatment in HPSAs. Under these programs, the Department of Health and Human Services agrees to repay the qualifying educational loans of selected primary care health professionals. In return, the health professionals agree to serve for a specified period of time in an NHSC-approved site located in a federally-designated HPSA approved by the Secretary for LRP participants. The forms utilized by each LRP include the following: the NHSC LRP Application, the Authorization for Disclosure of Loan Information form, the Privacy Act Release Authorization form, and if applicable, the Verification of Disadvantaged Background form and the Private Practice Option form. The first four of the aforementioned NHSC LRP forms collect information that is needed for selecting participants and repaying qualifying educational loans. The Private Practice Option Form, is needed to collect information for all participants who have applied for that service option. NHSC-approved sites are health care facilities that provide comprehensive outpatient, ambulatory, primary health care services to populations residing in HPSAs. Related in-patient services may be provided by NHSC-approved Critical Access Hospitals (CAHs) and Indian Health Service Hospitals. In order to become an NHSC-approved site, new sites must submit a Site Application for review and approval. Existing NHSC-approved sites are required to complete a Site Recertification Application in order to maintain their NHSC-approved status. Both the NHSC Site Application and Site Recertification Application request information on the clinical service site, sponsoring agency, recruitment contact, staffing levels, service users, charges for services, employment policies, and fiscal management capabilities. Assistance in completing these applications may be obtained through the appropriate State Primary Care Offices and the NHSC. The information collected on the applications is used for determining the eligibility of sites for the assignment of NHSC health professionals and to verify the need for NHSC clinicians. NHSC service site approval is valid for 3 years. Sites wishing to remain eligible for the assignment of NHSC providers must submit a Site Recertification Application every 3 years.

US Code: 42 USC 2541 - 1(c), 333 [254f] (a)(1) Name of Law: Public Health Service Act

Not associated with rulemaking

  84 FR 34402 07/18/2019
85 FR 5967 02/03/2020

  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 25,933 25,933 0 0 0 0
Annual Time Burden (Hours) 12,735 12,735 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
An increase in respondents has caused the increase in burden.

Elyana Bowman 301 443-3983 [email protected]


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:
    (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;
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.

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