OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Faculty Loan Repayment Program Application

IC 6381 under ICR 202311-0915-001 · OMB 0915-0150.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Faculty Loan Repayment Program Application
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction FLRP User Guide.pdf Yes No Fillable Fileable
Form and Instruction 2 01292024 Institution Loan Repayment Form.docx 01292024 Institution-Loan Repayment Employment Form.docx Yes Yes Fillable Fileable
Form 3 01292024 Authorization to Release Information Form.docx 01292024 Authorization to Release Information Form.docx Yes Yes Fillable Fileable
Form and Instruction 4 01262024 Disadvantaged Background Form.docx 01292024 Disadvantaged Background Form.docx Yes Yes Fillable Fileable

Health Health Care Services

HHS/HRSA/BHW Scholarship and Loan Repayment Program Records, 09–15–0037  86 FR 28362

860 0
   
Individuals or Households
 
   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 860 0 116 0 0 744
Annual IC Time Burden (Hours) 527 0 71 0 0 456
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.