Information Collection

Faculty Loan Repayment Program Application

IC 6381 under ICR 202101-0915-001 · OMB 0915-0150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0150 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Faculty Loan Repayment Program Application	Form and Instruction
1 FLRP Application and User Guide 2020.pdf FLRP User Guide 2020.pdf	Form and Instruction
1 FLRP Application and User Guide 2020.pdf FLRP User Guide 2020.pdf	Form and Instruction
2 Institution Loan Repayment Form.docx Institution Loan Repayment Form.docx	Form and Instruction
2 Institution Loan Repayment Form.docx Institution Loan Repayment Form.docx	Form and Instruction
3 Authorization to Release Information Form.docx Authorization to Release Information Form.docx	Form
3 Authorization to Release Information Form.docx Authorization to Release Information Form.docx	Form
4 Disadvantaged Background Form.docx Disadvantaged Background Form.docx	Form and Instruction
4 Disadvantaged Background Form.docx Disadvantaged Background Form.docx	Form and Instruction
Attachment A - FLRP Authorizing Legislation.docx Attachment A - FLRP Authorizing Legislation	IC Document
Attachment A - FLRP Authorizing Legislation.docx Attachment A - FLRP Authorizing Legislation	IC Document
Attachment B - FY 2020 FLRP APG.pdf Attachment B - FY 2020 FLRP APG	IC Document
Attachment B - FY 2020 FLRP APG.pdf Attachment B - FY 2020 FLRP APG	IC Document
Attachment C - FY 2020 FLRP Contract.pdf Attachment C - FY 2020 FLRP Contract	IC Document
Attachment C - FY 2020 FLRP Contract.pdf Attachment C - FY 2020 FLRP Contract	IC Document

IC Title:

Faculty Loan Repayment Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	FLRP Application and User Guide 2020.pdf	FLRP User Guide 2020.pdf	Yes	No	Fillable Fileable
Form and Instruction	2	Institution Loan Repayment Form.docx	Institution Loan Repayment Form.docx	Yes	Yes	Fillable Fileable
Form	3	Authorization to Release Information Form.docx	Authorization to Release Information Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	Disadvantaged Background Form.docx	Disadvantaged Background Form.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 744

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	744	522	222
Annual IC Time Burden (Hours)	456	206	250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A - FLRP Authorizing Legislation	Attachment A - FLRP Authorizing Legislation.docx	01/15/2021
Attachment B - FY 2020 FLRP APG	Attachment B - FY 2020 FLRP APG.pdf	01/15/2021
Attachment C - FY 2020 FLRP Contract	Attachment C - FY 2020 FLRP Contract.pdf	01/15/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.