Information Collection

Faculty Loan Repayment Program Application

IC 6381 under ICR 202608-0906-002 · OMB 0906-0082.

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 FLRP DAB Background Form Revised Clean- 5.8.26.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 FLRP DAB Background Form Revised Clean- 5.8.26.docx FLRP DAB Background Form Revised Clean- 5.8.26.docx	Form and Instruction
FLRP DAB Background Form Revised Redline - 5.8.26.pdf FLRP DAB Background Form Revised REDLINE 5.8.2026	IC Document
OMB NonSubstantive Change Request Memo - FLRP Program - CLEAN 2026-05-19.docx 2026 NCR for FLRP DAB Background Form Revised	IC Document

IC Title:

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
	Requested	Previously Approved
Annual Number of Responses for this IC	860	860
Annual IC Time Burden (Hours)	527	527
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FLRP DAB Background Form Revised REDLINE 5.8.2026		05/19/2026
2026 NCR for FLRP DAB Background Form Revised		05/19/2026

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

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