Specialty Education Loan Repayment Program (SELRP) Forms [AQ63]

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-XXX Specialty Education Loan Repayment Program (SELRP) - Participant Agreement	Form	Modified	Available
Form 10-XXX SELRP - Participant Agreement	Form	Modified	Repair queued
Form 10-XXX Specialty Education Loan Repayment Program (SELRP) - Service Period & Loan Repayment Verification	Form and Instruction	Modified	Available
Form 10-XXX SELRP - Service Period & Loan Repayment Verification	Form and Instruction	Modified	Repair queued
Form 10-XXX Specialty Education Loan Repayment Program (SELRP) - Education Loan Verification	Form and Instruction	Modified	Available
Form 10-XXX SELRP - Education Loan Verification	Form and Instruction	Modified	Repair queued
Form 10-XXX Specialty Education Loan Repayment Program (SELRP) - Program Status Verification	Form	Modified	Available
Form 10-XXX SELRP - Program Status Verification	Form	Modified	Repair queued
Form 10-XXX Specialty Education Loan Repayment Program (SELRP) - Application	Form and Instruction	Modified	Available
Form 10-XXX SELRP - Application	Form and Instruction	Modified	Repair queued
PRA Supp Statement A_Spec Educ Loan Repay Prog (SELRP)_AQ63_revised July 2020.docx	Supporting Statement A	Uploaded 2020-08-05	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241717	SELRP - Participant Agreement	Form	Modified	Specialty Education Loan Repayment Program (SELRP) - Participant Agreement
241717	SELRP - Participant Agreement	Form	Modified
241716	SELRP - Service Period & Loan Repayment Verification	Form and Instruction	Modified	Specialty Education Loan Repayment Program (SELRP) - Service Period & Loan Repayment Verification
241716	SELRP - Service Period & Loan Repayment Verification	Form and Instruction	Modified
241715	SELRP - Education Loan Verification	Form and Instruction	Modified	Specialty Education Loan Repayment Program (SELRP) - Education Loan Verification
241715	SELRP - Education Loan Verification	Form and Instruction	Modified
241714	SELRP - Program Status Verification	Form	Modified	Specialty Education Loan Repayment Program (SELRP) - Program Status Verification
241714	SELRP - Program Status Verification	Form	Modified
241713	SELRP - Application	Form and Instruction	Modified	Specialty Education Loan Repayment Program (SELRP) - Application
241713	SELRP - Application	Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0879	ICR Reference No: 202008-2900-002
Status: Historical Inactive	Previous ICR Reference No: 201912-2900-003
Agency/Subagency: VA	Agency Tracking No: 2900-0879
Title: Specialty Education Loan Repayment Program (SELRP) Forms [AQ63]
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 01/19/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/05/2020
Terms of Clearance: VA may resubmit this collection when it is ready for review. If submitted on or before 08/05/2021, the collection may be resubmitted to OMB review without being re-noticed in the Federal Register.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 303 of Public Law 115-182, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, or the VA MISSION Act of 2018, amended title 38 of the United States Code (U.S.C.) by establishing new sections 7691 through 7697 and created a new student loan repayment program known as the Specialty Education Loan Repayment Program (SELRP). The SELRP will serve as an incentive for physicians starting or currently in residency programs in medical specialties for which VA has determined that recruitment and retention of qualified personnel is difficult to work for VA at VA facilities that need more physicians with that medical specialty. On June 23, 2020, OMB assigned this IC a new Control Number: 2900-0879 Section 303 of the VA MISSION Act of 2018 did not establish an application procedure for the SELRP. To maintain consistency in the application process of similar VA scholarship programs and to ease the implementation such programs by VA personnel, VA will mirror proposed § 17.528 to current § 17.643, Application for the Program for Repayment of Educational Loans for Certain VA Psychiatrists (PREL.) Consistent with § 17.643(a), proposed paragraph § 17.528(a) will state that a complete application for the SELRP consists of a completed application, letters of reference, and personal statement.

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Authorizing Statute(s): PL: Pub.L. 115 - 182 303 Name of Law: MISSION Act of 2018
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AQ63	Final or interim final rulemaking	85 FR 45532	07/29/2020

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
SELRP - Application	10-XXX	Specialty Education Loan Repayment Program (SELRP) - Application
SELRP - Education Loan Verification	10-XXX	Specialty Education Loan Repayment Program (SELRP) - Education Loan Verification
SELRP - Participant Agreement	10-XXX	Specialty Education Loan Repayment Program (SELRP) - Participant Agreement
SELRP - Program Status Verification	10-XXX	Specialty Education Loan Repayment Program (SELRP) - Program Status Verification
SELRP - Service Period & Loan Repayment Verification	10-XXX	Specialty Education Loan Repayment Program (SELRP) - Service Period & Loan Repayment Verification

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: The Specialty Education Loan Repayment Program (SELRP) is a new program created under the MISSION Act of 2018, and all burden hours represent an increase for the IC.

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Annual Cost to Federal Government: $12,187

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? No

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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: 08/05/2020

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