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pdfOMB Number: 0915-0314; Expiration Date: XX/XX/20XX
Public Burden Statement: The NFLP-APR Financial Data Form will collect outcome and financial data to capture the NFLP loan
fund account activity related to financial receivables, disbursements, and borrower account data related to employment status,
loan cancellation, loan repayment and collections. Tracking of borrowers should cease when borrower accounts are closed due
to full repayment/cancellation/collection. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The OMB control number for this information
collection is 0915-0314 and it is valid until 07/31/2020. This information collection is required to obtain or retain a benefit (42
U.S.C. 297n-1). Public reporting burden for this collection of information is estimated to average 6 hours per response, including
the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or
[email protected].
NFLP Annual Performance Report (APR) Financial Data Form
Institution Name: ______________________________________________________________
NFLP-APR Report Period: _______ NFLP-APR Number: _______ Grant Number: _______
NFLP-1 PROGRAM ACCOUNTS SECTION
PROGRAM ACCOUNTS
A.
FEDERAL FUNDS AWARDED
B.
CASH BALANCE - START OF REPORT PERIOD
C.
CASH RECEIPTS
D.
1.
Federal Funds Received (Funds Drawn Down from PMS)
2.
Institutional Capital Contribution Deposited
3.
Loan Principal Collected
4.
Interest Income Collected on Loans
5.
Penalty Charges Collected on Loans
6.
Investment Income
7.
Institutional Repayments of Bad Debts, Principal
8.
Institutional Repayments of Bad Debts, Interest
9.
Institutional Repayments of Bad Debts, Penalty Charges
10.
CASH RECIEPTS TOTAL (Add C.1 - C.9)
CASH DISBURSEMENTS
1.
NFLP Loans to Students
2.
Repayments to Federal Government, Principal
3.
Repayments to Federal Government, Interest
4.
Repayments to Federal Government, Other Income
5.
Repayments to Institution, Principal
6.
Repayments to Institution, Interest
7.
Repayments to Institution, Other Income
8.
Collection Agent Costs, Principal
9.
Collection Agent Costs, Interest
10.
Litigation Costs, Principal
Cumulative
Current Year
E.
11.
Litigation Costs, Interest
12.
Credit Bureau Fees
13.
Other Costs
14.
CASH DISBURSEMENTS TOTAL (Add D.1 - D.13)
CASH BALANCE – END OF REPORT PERIOD
GRANT NUMBER: _________ NFLP-APR NUMBER: __________ INSTITUTION: _____________________
NFLP –2 PROGRAM ACCOUNTS SECTION
PROGRAM ACCOUNTS
(Continued)
Cumulative
Number of
Borrowers
F.
Interest
Number of
Borrowers
Principal
Interest
Interest
Penalty
Charge
LOAN CANCELLATIONS
TO BORROWERS
1. Nursing Employment
Nursing Employment
a.
–Yr. 1 (20%)
Nursing Employment
b.
–Yr. 2 (20%)
Nursing Employment
c.
–Yr. 3 (20%)
Nursing Employment
d.
–Yr. 4 (25%)
2. Death of Borrower
On NFLP Loans made on
or after 7/22/2003
3.
G.
Principal
Current Year
Permanent & Total Disability Approved by HHS
On NFLP Loans made on
or after 7/22/2003
BAD DEBTS
APPROVED
FOR WRITEOFF BY HHS
Number
of
Borrowers
Principal
Interest
Penalty
Charge
Number
of
Borrowers
Principal
Total Approved
NFLP – 3 PROGRAM ACCOUNTS SECTION
H. DEFAULT RATE (Not Applicable to NFLP)
I.
CHECK LIST/QUESTIONS
1.
What is the total amount of interest that is past due? $____________
AUDITS
2.
Does your institution provide for a biennial audit of the loan funds by a qualified independent auditor?
______Yes ______No ______N/A
Period of Last Audit:
From Date:
To Date:
___________ (Month/Year)
___________ (Month/Year)
Date audit submitted to Regional Audit Agency? ________ (Month/Year)
GRANT NUMBER: _________ NFLP-AOR NUMBER: __________ INSTITUTION: _____________________
NFLP – 4 BORROWER ACCOUNTS WORKSHEET
BORROWER ACCOUNTS
1. FULLY RETIRED
A. Repayment/Cancellation
B. Cancellation/Death
C. Cancellation/Disability
D. Discharged in Bankruptcy
E. HHS Approved Write-off
F. Uncollectible per P.L. 107-205
2. CURRENT
A. Student Status
B. Grace Period
C. Deferment Status
D. Postponement/Cancellation
E. Repayment – Not Past Due
F. Past Due 1-119 Days
3. IN BANKRUPTCY
Per Discharge/Wage Earners
A. Agreement
4.
IN DEFAULT
A. 120 Days and Over
5. FORBEARANCE
A.
Forbearance
TOTAL:
Number of
Borrowers
Principal
Loaned
Principal
Repaid
PRINCIPAL
CANCELLED
Upon
Employment
Upon
as Nurse
Death/
Faculty
Disability
Principal
Delinquent
Principal
Uncollectible
Not Past Due
Principal
Outstanding
but Not Due
Principal
Written Off
Nurse Faculty Loan Program
ANNUAL PERFORMANCE REPORTFINANCIAL DATA FORM
INSTRUCTIONS
Tracking Information: These forms are needed to track borrowers from enrollment to post graduation as applicable.
Borrowers should only be tracked while they are enrolled or during the period of loan cancellation, repayment or
collection. Tracking of borrowers should cease when borrower accounts are closed due to full
repayment/cancellation/collection.
NFLP –1 Program Accounts Section (Negative amounts should not be entered for this section.)
Item A:
Federal Funds Awarded: The amount should reflect the Federal Capital Contribution (FCC)
amount shown on the fiscal year Notice of Award for the current year and the cumulative amount
of awards made to your institution since beginning the NFLP. This data will be pre-populated (not
editable).
Item B:
Cash Balance-Start of Report Period: The amount should reflect the ending “cash balance”
from the institution’s prior Annual Performance Report (APR). This data will be pre-populated
(not editable).
Item C:
Item C.1:
Cash Receipts (Funds Deposited)
Federal Capital Contribution (FCC) Drawn from PMS and Deposited: The amount should
reflect the total FCC actually drawn down from the Payment Management System and deposited
into the NFLP fund. Report the amount of the FCC drawn-down by the institution for the current
year.
Item C.2:
Institutional Capital Contributions (ICC) Deposited: The amount must equal at least one-ninth
of the Federal Capital Contribution funds drawn down. Report the amount of the ICC (1/9 of the
total FCC) deposited into the NFLP fund for the current year.
Item C.3:
Loan Principal Collected: Report the amount of loan principal collected from borrowers for the
current year.
Item C.4:
Interest Income Collected on Loans: Report the amount of interest on loan principal collected
from borrowers for the current year.
Item C.5:
Penalty Charges Collected on Loans: Report the amount of penalty charges collected from
borrowers for the current year.
Item C.5-6:
Investment Income: Report the amount of earnings on NFLP funds deposited in any type of
interest-bearing account for the current year. NOTE: Any fund established by a school with
Federal Capital Contributions must be accounted for separately from other funds, providing a
clear audit trail for all transactions. The school must at all times maintain all monies relating to
the fund in one or more interest-bearing accounts or investment instruments which meet OMB
requirements established for Federal monies held by third parties. The school must place all
earnings into the fund but may first deduct from total earnings any reasonable and customary
charges incurred through the use of an interest-bearing account.
Items C.7-9:
Institutional Repayments of Bad Debts, Principal, Interest and Penalty Charges: Report the
amount of any repayments of bad debt (principal, interest and penalty charges) collected for the
current year. NOTE: Institutions have the ultimate responsibility for bad debts losses not
approved for write-off by the Department of Health and Human Services (DHHS). There is
nothing to prevent an institution from further pursuing the collection of a bad debt after it has
been disapproved for write-off by DHHS; any amounts recovered would lessen the institution’s
liability.
Item C.10:
Cash Receipts Total: Report the total amount of items C.1 through C.9 for the current year.
Item D.1:
Loaned to Students: Report the total amount of NFLP funds loaned to students for the current
year.
Item D.2-4:
Repayments to Federal Government - Principal, Interest and Other Income: Report the total
amounts repaid to Federal Government for the current year. NOTE: Repayments to Federal
Government is excess cash returned to the Division of Payment Management. DO NOT include
amounts returned to PMS because those amounts should be adjusted against Federal Funds
Received within the appropriate award period.
Item D.5:
Repayments to Institution, Principal: Report the total amount of loan principal repaid to the
institution for the current year and cumulative period. Example: The institution’s proportionate
share of excess cash in the NFLP fund that has been repaid to the institution. DO NOT show
withdrawal of funds as a result of excess institutional contributions in this item.
Item D.6:
Repayments to Institution, Interest: Report the total amount of interest on student loans repaid
to the institution for the current year and cumulative period.
Item D.7:
Repayments to Institution, Other Income: Report the total amount of other income repaid to the
institution for the current year and cumulative period. NOTE: This item would include any
amounts in items C.6, C.7 and C.8 that were repaid to the institution in conjunction with a
repayment to the Federal government.
Item D.8-9:
Collection Agent Costs-Principal & Interest: The full amount of principal and interest collected
must be reported in items C.4, C.5 and C.6. The associated collection costs must be prorated. See
example below.
Litigation Costs-Principal & Interest: Litigation costs associated with the collection of a loan
and interest must be prorated in the same manner as collection costs. See example below.
Item D.10-11:
The following method of reporting is required even if the collection agency and/or attorney remit
only the net amount (collections less collection of litigation costs) to the institution. If the
institution is able to get the borrower to pay the collection costs or the litigation costs, the costs
are not charged to the fund.
EXAMPLES OF PRORATING COLLECTION COSTS (Litigation Costs to Be Prorated in Same
Manner):
An institution directs a collection agency to collect $1,000.00 principal and $200.00 interest for a
total of $1,200.00 from a delinquent borrower. The collection agency collects all $1,200.00 but
deducts $360.00, or 30% of the amount collected, before remitting the net amount of $840.00 to
the institution. The institution reports as follows:
Loan Principal Collected $1,000.00
Interest Income Collected 200.00
Collection Costs, Principal (30% x $1,000) 300.00
Collection Costs, Interest (30% x $200) 60.00
An institution directs a collection agency to collect $1,500.00 principal and $500.00 interest for a
total of $2,000.00 from a delinquent borrower. At the end of the report period, the collection
agency has collected $1,600.00 (80% of $2,000.00), which it remits to the institution with a bill for
$480.00 (30% of the $1,600.00 collected). The institution pays the collection agency $480.00
taken from the Fund and reports as follows:
Loan Principal Collected (80% of the $1,500) $1,200.00
Item D.12:
Item D.13:
Interest Income Collected (80% of $500) 400.00
Collection Costs, Principal (30% of $1,200) 360.00
Collection Costs, Interest (30% of $400) 120.00
Credit Bureau Costs: Report the total amount of cost associated with charges from Credit
Bureaus related to collection of loans for the current year.
Other Costs: Report the total amount of other costs charged to the fund (i.e., overpayments and
underpayments of $10.00 or less) for the current year and cumulative period. Note: DO NOT
include administrative costs such as BILLING AGENCY COSTS, SALARIES, STAMPS, BANK
CHARGES, and the like, incurred by the institution.
Item D.14:
Cash Disbursements Total: Report the total amount of items D.1 through D.14 for the current
year.
Item E.
Cash Balance – End of Report Period: This amount should equal the actual cash on hand and in
the NFLP fund for the current year.
NFLP – 2 Program Accounts Section
Item F:
Loan Cancellations to Borrowers
Item F.1:
Nursing Employment: Under the appropriate column headings for years 1-4 Nursing
Employment, report the current year number of borrowers and the amounts of principal and
interest on NFLP loans.
Item F.2:
Death of Borrower: Report only the information for loans made on or after July 22, 2003.
Under the appropriate column headings, report the current and cumulative number of borrowers
and the amounts of principal and interest that were approved for cancellation by the institution due
to death.
Item F.3:
Permanent and Total Disability Approved by HHS: Report only the information for loans
made on or after July 22, 2003. Under the appropriate column headings, report the current and
cumulative number of borrowers and the amounts of principal and interest that has been approved
for cancellation by DHHS due to permanent and total disability.
Item G:
Bad Debts Approved for Write-off by DHHS: Report amounts for write-off and any
subsequent collections that are received and have been approved for write-off by HHS.
NFLP – 3 Program Accounts Section
Item H:
Default Rate: Not Applicable to NFLP.
Item I:
1.
Check List/Questions: Report the total amount of interest that is past due.
2.
Audits: Provide latest A-133 Audit information.
NFLP – 4 Borrower Accounts Worksheet
In completing this section, schools must report the status of all borrower accounts as of the end of this reporting
period (June 30) — not just the accounts that changed status during this reporting period.
COLUMNS - Description of Required Information:
NUMBER OF BORROWERS – The number of borrowers who received loans. The column total should
coincide with the number reported on Page 1, #5 (Cumulative Number of NFLP Student Borrowers).
PRINCIPAL LOANED – The dollar amount of loan principal disbursed. The column total should coincide
with the amount reported on Page 1, #8 (Cumulative Amount of NFLP Loans Made).
PRINCIPAL REPAID – The dollar amount of loan principal and interest repaid. The column total should
coincide with the CUMULATIVE amounts reported on Page 2, Line 4 (Loan Principal Collected) plus Line 8
(Institutional Repayments of Bad Debt/Principal).
PRINCIPAL CANCELLED – Upon Employment as Nurse Faculty – the dollar amount of loan principal
cancelled for employment. The column total should coincide with the CUMULATIVE total of amounts
reported on Page 3, Line F.2d, F.2.e, F.2.f, F.2.g (Principal).
PRINCIPAL CANCELLED – Upon Death/Disability – The dollar amount of loan principal cancelled due to
the death or permanent and total disability of the borrower.
PRINCIPAL DELINQUENT – The dollar amount of loan principal that is delinquent. Include only the
amount of those payments that are in deferment.
PRINCIPAL UNCOLLECTIBLE NOT PAST DUE – The dollar amount of loan principal not past due
which the school has determined to be uncollectible after exercising due diligence in the collection of loans.
DO NOT duplicate any of these amounts in OUTSTANDING BUT NOT DUE column.
PRINCIPAL OUTSTANDING BUT NOT DUE – The dollar amount of loan principal outstanding but not
yet due according to the original or renegotiated repayment schedule. DO NOT duplicate any amounts in
UNCOLLECTABLE NOT PAST DUE column.
PRINCIPAL WRITTEN OFF – The dollar amount of loan principal which has been written off pursuant to
receiving written authorization from the DHHS.
CAPITALIZED INTEREST– No application to NFLP.
ROWS - Description of Required Information:
1. FULLY RETIRED (Borrowers accounts that are closed due to full repayment/cancellation/collection, death,
disability, bankruptcy, write-off, uncollectible)
1. A: Report the information pertaining to borrowers who have fully retired their loans through cash repayments
and/or through cancellation for eligible employment/professional practice.
1. B: Report the information pertaining to loans that have been fully retired due to death of the borrower.
1. C: Report the information pertaining to borrowers whose loans have been fully retired due to total disability.
1. D: Report the information pertaining to borrowers who have fully retired their loans through discharge in
bankruptcy and have not received write-off approval.
1. E: Report the information pertaining to borrowers whose loans have been fully retired due to DHHS approved
write-off.
1. F: Report the information pertaining to borrowers whose loans are uncollectible in accordance with the HRSA
Student Financial Aid Guidelines-Fiscal Management: Collections.
2. CURRENT (Borrowers accounts that are active based on status as – NFLP student enrollment, grace period,
deferment, cancellation, repayment, past due).
2. A: Report the information pertaining to borrowers who are currently in student status working toward the degree
for which they obtained their loans.
2. B: Report the information pertaining to borrowers who are currently in the grace period due to termination or
completion of the course of study for which they obtained their loans.
2. C: Report the information pertaining to borrowers who are currently in deferment as specified on the NFLP
Promissory Notes.
2. D: Report the information pertaining to borrowers who are currently engaged in employment that qualifies them
for cancellation, who have filed a Request for Postponement of Installment Payment, and who are not past due on
any payment.
2. E: Report the information pertaining to borrowers who are making payments in accordance with their repayment
schedules.
2. F: Report the information pertaining to borrowers who have installments past due according through deferment or
in postponement for cancellation and who are also past due on any prior payments.
3. IN BANKRUPTCY
3. A: Report the information pertaining to borrowers who are currently making payments under a wage earner’s
agreement (Chapter 13 proceedings).
4. IN DEFAULT
4. A: Report the information pertaining to borrowers who are in default in their repayments (120 days and over).
5. FORBEARANCE
5. A: Report the information pertaining to borrowers who are currently in forbearance.
TOTAL: Summarize and provide totals for the information on ALL ACCOUNTS of ALL BORROWERS who
have ever received a loan through the NFLP program.
| File Type | application/pdf |
| File Title | EXHIBIT B-1 |
| Author | HRSA |
| File Modified | 2020-08-03 |
| File Created | 2020-08-03 |