Faculty Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 01262024 Disadvantaged Background Form.docx	Form and Instruction	Modified	Available
Form 3 01292024 Authorization to Release Information Form.docx	Form	Modified	Available
Form 2 01292024 Institution Loan Repayment Form.docx	Form and Instruction	Modified	Available
Form 1 Faculty Loan Repayment Program Application	Form and Instruction	Modified	Repair queued
FLRP Supporting Statement 11162023.docx	Supporting Statement A	Uploaded 2023-11-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified	01262024 Disadvantaged Background Form.docx
6381	Faculty Loan Repayment Program Application	Form	Modified	01292024 Authorization to Release Information Form.docx
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified	01292024 Institution Loan Repayment Form.docx
6381	Faculty Loan Repayment Program Application	Form and Instruction	Modified
6381	Faculty Loan Repayment Program Application	Instruction	Modified

ICR Details

OMB Control No: 0915-0150	ICR Reference No: 202311-0915-001
Status: Historical Active	Previous ICR Reference No: 202101-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Faculty Loan Repayment Program
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: 01/31/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/17/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2027	36 Months From Approved	03/31/2024
Responses	860	0	744
Time Burden (Hours)	527	0	456
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected will be used to evaluate applicants’ eligibility to participate in the Faculty Loan Repayment Program (FLRP), administered by the Bureau of Health Workforce, Department of Health and Human Services (HHS). The information collected will be used to evaluate applicants’ rank and tier in the FLRP award process and to monitor FLRP-related activities.

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Authorizing Statute(s): US Code: 42 USC 293b Name of Law: Public Health Service Act
   PL: Pub.L. 105 - 392 738(a) Name of Law: Health Professions Education Partnerships Act of 1998
  

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 60693	09/05/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 78758	11/16/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Faculty Loan Repayment Program Application	2, 3, 4	01292024 Institution Loan Repayment Form.docx ,   01292024 Authorization to Release Information Form.docx ,   01262024 Disadvantaged Background Form.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	860	744	0	116	0	0
Annual Time Burden (Hours)	527	456	0	71	0	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 burden hours increased due to an increase in the number of respondents.

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Annual Cost to Federal Government: $292,060

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: 11/17/2023

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