Information Collection Request

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

ICR 202305-0906-003 · OMB 0906-0058 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0906-0058 can be found here:

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	Missing upstream
Form 7 PS LRP Privacy Act Release Authorization Form	Form and Instruction	New	Repair queued
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	Repair queued
Form 5 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Site Application	Form and Instruction	Removed	Missing upstream
Form 4 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Employment Verification Form	Form and Instruction	Modified	Missing upstream
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 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 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

Information collection document groups
IC ID	Collection	Type	Status
260337	PS LRP Employment Verification Form	Form and Instruction	New
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
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
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
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

Record metadata
Status	Received in OIRA
Agency/Subagency	HHS/HRSA
OMB Control No	0906-0058
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202009-0906-001
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31