Information Collection

Faculty Loan Repayment Program Application

IC 6381 under ICR 202401-0906-005 · OMB 0906-0082.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0082 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 01292024 Institution Loan Repayment Form.docx Faculty Loan Repayment Program Application	Form and Instruction
Form 3 01292024 Authorization to Release Information Form.docx Faculty Loan Repayment Program Application	Form
Form 4 01262024 Disadvantaged Background Form.docx Faculty Loan Repayment Program Application	Form and Instruction
FLRP User Guide.pdf	Instruction
2 01292024 Institution Loan Repayment Form.docx 01292024 Institution-Loan Repayment Employment Form.docx	Form and Instruction
3 01292024 Authorization to Release Information Form.docx 01292024 Authorization to Release Information Form.docx	Form
4 01262024 Disadvantaged Background Form.docx 01292024 Disadvantaged Background Form.docx	Form and Instruction

IC Title:

Faculty Loan Repayment Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	No	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form	3	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: HHS/HRSA/BHW Scholarship and Loan Repayment Program Records, 09â15â0037

FR Citation: 86 FR 28362

Number of Respondents: 860

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	860	116	744
Annual IC Time Burden (Hours)	527	71	456
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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