OMB control number

Faculty Loan Repayment Program

OMB 0906-0082 · HHS/HRSA.

OMB 0906-0082

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.

The latest form for Faculty Loan Repayment Program expires 2027-01-31 and is listed under ICR 202608-0906-002.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 4 FLRP DAB Background Form Revised Clean- 5.8.26.docx	Form and Instruction
Form 3 01292024 Authorization to Release Information Form.docx	Form
Form 2 01292024 Institution Loan Repayment Form.docx	Form and Instruction
Form 6 Participant Semi-Annual In Service Verification Form	Form and Instruction
Form 4 Certification of Vulnerable Background Form	Form and Instruction
Form 3 Authorization to Release Information Form	Form
Form 5 Employer’s Agreement to Loan Repayment Match/Request for a Waiver of the Loan Repayment Match Form	Form
Form 2 Institution/Loan Repayment Employment Form	Form and Instruction
Form 1 FLRP Application	Form and Instruction
FLRP Supporting Statement - Final.docx	Supporting Statement A
Faculty Loan Repayment Program Application	Form and Instruction
Faculty Loan Repayment Program Application	Form
Faculty Loan Repayment Program Application	Form and Instruction
Faculty Loan Repayment Program Application	Instruction
Participant Semi-Annual In Service Verification Form	Form and Instruction
Certification of Vulnerable Background Form	Form and Instruction
Authorization to Release Information Form	Form
Employer's Agreement to Loan Repayment Match/Request for a Waiver of the Loan Repayment Match Form	Form
Institution/Loan Repayment Employment Form	Form and Instruction
Eligible Applications	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202611-0906-001	Revision of a currently approved collection	2026-11-03
202608-0906-002	No material or nonsubstantive change to a currently approved collection	2026-08-07
202401-0906-005	Revision of a currently approved collection	2024-01-31	Approved with change