Information Collection Request
NURSE Corps Loan Repayment Program
ICR 202301-0915-001 · OMB 0915-0140 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0915-0140 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 1 NURSE Corps LRP Application |
Form and Instruction | Modified | Repair queued |
| Form 1 Nurse Corps Nurse Faculty Employment Verification Form |
Form and Instruction | Modified | Repair queued |
| Form 2 Nurse Corps Crtiical Shortage Facility (CSF) Verification Form |
Form and Instruction | Modified | Repair queued |
| Form 3 Participant Semi-Annual in Service Verification Form |
Form and Instruction | Modified | Repair queued |
| Form 4 Confirmation of Interest Form |
Form and Instruction | Modified | Repair queued |
| Form 5 Disadvantaged Background Form |
Form and Instruction | Modified | Repair queued |
| Form 6 Authorization to Release Information Form |
Form and Instruction | Modified | Repair queued |
| Form 7 Employment Verification Form |
Form and Instruction | Modified | Missing upstream |
 NC LRP - Supporting Statement A.docx |
Supporting Statement A | Uploaded 2023-01-05 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 6368 |  NURSE Corps LRP Application |
Form and Instruction | Modified | |
| 239781 | Nurse Corps Nurse Faculty Employment Verification Form |
Form and Instruction | Modified | |
| 239779 | Nurse Corps Crtiical Shortage Facility (CSF) Verification Form |
Form and Instruction | Modified | |
| 239777 | Participant Semi-Annual in Service Verification Form |
Form and Instruction | Modified | |
| 239776 | Confirmation of Interest Form |
Form and Instruction | Modified | |
| 239775 | Disadvantaged Background Form |
Form and Instruction | Modified | |
| 239774 | Authorization to Release Information Form |
Form and Instruction | Modified | |
| 182803 | Employment Verification Form |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/HSA |
| OMB Control No | 0915-0140 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202002-0915-001 |
| Agency Tracking No | 21547 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |