Information Collection Request

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

ICR 202512-0906-006 · OMB 0906-0058 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 8 PS LRP Employment Verification Form Form and Instruction Modified Available
Form 7 PS LRP Privacy Act Release Authorization Form Form and Instruction Modified Available
Form 6 PS LRP Auth for Disc of Loan Info Form Form and Instruction Modified Available
Form 5 PS LRP Application Form and Instruction Modified Available
Form 4 STAR LRP Employment Verification Form Form and Instruction Modified Available
Form 3 STAR LRP Privacy Act Release Authorization Form Form and Instruction Modified Available
Form 2 STAR LRP Authorization for Disclosure of Loan Information Form Form and Instruction Modified Available
Form 1 STAR LRP Program Application Form and Instruction Modified Available
AAP CHA Comments PSLRP Information Collection Request.pdf Public Comments Uploaded 2025-10-14 Repair queued
SS-A - 0906-0058_BHW_ STAR LRP + Ped Spec LRP_12182025.docx Supporting Statement A Uploaded 2025-12-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
260337 PS LRP Employment Verification Form Form and Instruction ModifiedPS LRP Employment Verification Form
260336 PS LRP Privacy Act Release Authorization Form Form and Instruction ModifiedPS LRP Privacy Act Release Authorization Form
260334 Pediatric Specialty LRP Authorization for Disclosure of Loan Information Form Form and Instruction ModifiedPS LRP Auth for Disc of Loan Info Form
260333 Pediatric Specialty LRP Application Form and Instruction ModifiedPS LRP Application
243487 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Employment Verification Form Form and Instruction ModifiedSTAR LRP Employment Verification Form
243486 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Privacy Act Release Authorization Form Form and Instruction ModifiedSTAR LRP Privacy Act Release Authorization Form
243485 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information Form and Instruction ModifiedSTAR LRP Authorization for Disclosure of Loan Information Form
243484 Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Program Application Form and Instruction ModifiedSTAR LRP Program Application

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 07/31/2026
8,800 14,800
4,400 7,400
0 0





Reginfo record details
8
table that charts list of burden
IC Title Form No. Form Name
PS LRP Privacy Act Release Authorization Form 7
Pediatric Specialty LRP Authorization for Disclosure of Loan Information Form 6
PS LRP Employment Verification Form 8
Pediatric Specialty LRP Application 5
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Authorization for Disclosure of Loan Information 2
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Employment Verification Form 4
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Privacy Act Release Authorization Form 3
Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) Program Application 1

table that charts list of burden
  Total Request 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 8,800 14,800 0 -6,000 0 0
Annual Time Burden (Hours) 4,400 7,400 0 -3,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No