Faculty Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Disadvantaged Background Form.docx	Form and Instruction	Modified	Available
Form 3 Authorization to Release Information Form.docx	Form	Modified	Available
Form 2 Institution Loan Repayment Form.docx	Form and Instruction	Modified	Available
Form 2 Faculty Loan Repayment Program Application	Form and Instruction	Modified	Repair queued
Form 1 FLRP Application and User Guide 2020.pdf	Form and Instruction	Modified	Available
FLRP Supporting Statement - Final.docx	Supporting Statement A	Uploaded 2021-01-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified	Disadvantaged Background Form.docx
6381	Faculty Loan Repayment Program Application	Form	Modified	Authorization to Release Information Form.docx
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified	Institution Loan Repayment Form.docx
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified	FLRP Application and User Guide 2020.pdf

ICR Details

OMB Control No: 0915-0150	ICR Reference No: 202101-0915-001
Status: Historical Active	Previous ICR Reference No: 201806-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Faculty Loan Repayment Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/10/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/19/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2024	36 Months From Approved	08/31/2021
Responses	744	0	222
Time Burden (Hours)	456	0	250
Cost Burden (Dollars)	0	0	0

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Abstract: The need and purpose of this information collection is to obtain information to consider applicants for a Faculty Loan Repayment Program contract award. Applicants must submit a Disadvantaged Background Form as a requirement of the application to determine the applicant’s eligibility to participate in the program and competitiveness in rank for award funding. Respondents include individuals who have a health professions degree or certificate to serve as faculty members in eligible, accredited health professions schools.

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Authorizing Statute(s): PL: Pub.L. 105 - 392 738(a) Name of Law: Health Professions Education Partnerships Act of 1998
   US Code: 42 USC 293b Name of Law: Public Health Service Act
  

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:
	85 FR 63120	10/06/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 4099	01/15/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Faculty Loan Repayment Program Application	2, 3, 1, 4	FLRP Application and User Guide 2020.pdf ,   Institution Loan Repayment Form.docx ,   Authorization to Release Information Form.docx ,   Disadvantaged Background Form.docx

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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	744	222	0	522	0	0
Annual Time Burden (Hours)	456	250	0	206	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: No

Burden Reduction Due to:

Short Statement: The increase in burden is due to an increase in estimated responses and the addition of the Disadvantaged Background form to this information collection request.

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Annual Cost to Federal Government: $201,372

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: 01/19/2021

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