Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 8 PS LRP Employment Verification Form	Form and Instruction	New	Available
Form 8 PS LRP Employment Verification Form	Form and Instruction	New	Repair queued
Form 7 Privacy Act Release Authorization Form	Form and Instruction	New	Available
Form 7 PS LRP Privacy Act Release Authorization Form	Form and Instruction	New	Repair queued
Form 6 Pediatric Specialty LRP Auth for Disc of Loan Info Form	Form and Instruction	New	Available
Form 6 Pediatric Specialty LRP Authorization for Disclosure of Loan Information Form	Form and Instruction	New	Repair queued
Form 5 Pediatric Specialty LRP Application	Form and Instruction	New	Available
Form 5 Pediatric Specialty LRP Application	Form and Instruction	New	Repair queued
Form 5 FY 2021 STAR LRP Site Application.docx	Form and Instruction	Removed	Available
Form 5 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Site Application	Form and Instruction	Removed	Repair queued
Form 4 STAR LRP Employment Verification Form	Form and Instruction	Modified	Available
Form 4 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Employment Verification Form	Form and Instruction	Modified	Repair queued
Form 3 STAR LRP Privacy Act Release Authorization Form	Form and Instruction	Modified	Available
Form 3 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Privacy Act Release Authorization Form	Form and Instruction	Modified	Repair queued
Form 2 Authorization for Disclosure of Loan Information Form	Form and Instruction	Modified	Available
Form 2 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information	Form and Instruction	Modified	Repair queued
Form 1 STAR LRP Program Application Content	Form and Instruction	Modified	Available
Form 1 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Program Application	Form and Instruction	Modified	Repair queued
STAR LRP + Ped Spec LRP Supporting Statement -.docx	Supporting Statement A	Uploaded 2023-05-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260337	PS LRP Employment Verification Form	Form and Instruction	New	PS LRP Employment Verification Form
260337	PS LRP Employment Verification Form	Form and Instruction	New
260336	PS LRP Privacy Act Release Authorization Form	Form and Instruction	New	Privacy Act Release Authorization Form
260336	PS LRP Privacy Act Release Authorization Form	Form and Instruction	New
260334	Pediatric Specialty LRP Authorization for Disclosure of Loan Information Form	Form and Instruction	New	Pediatric Specialty LRP Auth for Disc of Loan Info Form
260334	Pediatric Specialty LRP Authorization for Disclosure of Loan Information Form	Form and Instruction	New
260333	Pediatric Specialty LRP Application	Form and Instruction	New	Pediatric Specialty LRP Application
260333	Pediatric Specialty LRP Application	Form and Instruction	New
243488	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Site Application	Form and Instruction	Removed	FY 2021 STAR LRP Site Application.docx
243488	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Site Application	Form and Instruction	Removed
243487	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Employment Verification Form	Form and Instruction	Modified	STAR LRP Employment Verification Form
243487	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Employment Verification Form	Form and Instruction	Modified
243486	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Privacy Act Release Authorization Form	Form and Instruction	Modified	STAR LRP Privacy Act Release Authorization Form
243486	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Privacy Act Release Authorization Form	Form and Instruction	Modified
243485	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information	Form and Instruction	Modified	Authorization for Disclosure of Loan Information Form
243485	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information	Form and Instruction	Modified
243484	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Program Application	Form and Instruction	Modified	STAR LRP Program Application Content
243484	Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Program Application	Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0058	ICR Reference No: 202305-0906-003
Status: Historical Active	Previous ICR Reference No: 202009-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/06/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/24/2023
Terms of Clearance: The agency shall consider APA comment dated 06/16 in future STAR and PSLRP application cycles after that date.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved	12/31/2023
Responses	14,800	0	1,600
Time Burden (Hours)	7,400	0	1,000
Cost Burden (Dollars)	0	0	0

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Abstract: Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the ‘‘SUPPORT for Patients and Communities Act 2020 requires an STAR LRP application. The legislative authority stating the need for the information collected in this application is found in Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the ‘‘SUPPORT for Patients and Communities Act 2020. The Bureau of Health Workforce (BHW) in the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) will administer the STAR LRP. Under the STAR LRP, HHS will enter into contracts with selected primary care health professionals including behavioral health providers and paraprofessionals. In return, HHS will assist the awardees in their repayment of outstanding qualifying educational loans.

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Authorizing Statute(s): PL: Pub.L. 115 - 271 0 Name of Law: SUPPORT for Patients and Communities Act 2020
  

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:
	88 FR 14373	03/08/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 32233	05/19/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
PS LRP Privacy Act Release Authorization Form	7	Privacy Act Release Authorization Form
Pediatric Specialty LRP Authorization for Disclosure of Loan Information Form	6	Pediatric Specialty LRP Auth for Disc of Loan Info Form
PS LRP Employment Verification Form	8	PS LRP Employment Verification Form
Pediatric Specialty LRP Application	5	Pediatric Specialty LRP Application
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information	2	Authorization for Disclosure of Loan Information Form
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Employment Verification Form	4	STAR LRP Employment Verification Form
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Privacy Act Release Authorization Form	3	STAR LRP Privacy Act Release Authorization Form
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Program Application	1	STAR LRP Program Application Content
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Site Application	5	FY 2021 STAR LRP Site Application.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	14,800	1,600	0	13,600	-400	0
Annual Time Burden (Hours)	7,400	1,000	0	6,800	-400	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 addition of the Pediatric Specialty LRP program, and the removal of the STAR LRP Site application form account for program burden changes sustained to the information collection request.

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Annual Cost to Federal Government: $623,295

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: 05/24/2023

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