OMB
.report
Search
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) and the Pediatric Specialty Loan Repayment Program
OMB: 0906-0058
IC ID: 243485
OMB.report
HHS/HRSA
OMB 0906-0058
ICR 202307-0906-003
IC 243485
( )
Documents and Forms
Document Name
Document Type
Form 2
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information
Form and Instruction
Form 2
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information
Form and Instruction
2 Authorization for Disclosure of Loan Information Form
PS LRP Auth for Disc of Loan Info Form.docx
Form and Instruction
2 Authorization for Disclosure of Loan Information Form
PS LRP Auth for Disc of Loan Info Form.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
2
Authorization for Disclosure of Loan Information Form
PS LRP Auth for Disc of Loan Info Form.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
3,200
0
0
0
0
3,200
Annual IC Time Burden (Hours)
1,600
0
0
0
0
1,600
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.