Information Collection

SELRP - Participant Agreement

IC 241717 under ICR 202102-2900-002 · OMB 2900-0879.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-255e SELRP - Participant Agreement	Form
10-255e Specialty Education Loan Repayment Program (SELRP) - Par VA Form 10-255e_SELRP Participant Agreement.pdf	Form
10-255e Specialty Education Loan Repayment Program (SELRP) - Par VA Form 10-255e_SELRP Participant Agreement.pdf	Form

IC Title:

Agency IC Tracking Number:

2900-NEW

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 17

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-255e	Specialty Education Loan Repayment Program (SELRP) - Participant Agreement	VA Form 10-255e_SELRP Participant Agreement.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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