The National Health Service Corps (NHSC) Loan Repayment Programs

OMB 0915-0127

OMB 0915-0127

The National Health Service Corps (NHSC) Loan Repayment Program (LRP) was established to assure an adequate supply of trained primary care health professionals to provide services in the neediest Health Professional Shortage Areas (HPSAs) of the United States. The NHSC Substance Use Disorder (SUD) Workforce LRP and the Rural Community LRP were established to recruit and retain a health professional workforce with specific training and credentials to provide evidence-based SUD treatment in HPSAs. Under these programs, the Department of Health and Human Services agrees to repay the qualifying educational loans of selected primary care health professionals. In return, the health professionals agree to serve for a specified period of time in an NHSC-approved site located in a federally-designated HPSA approved by the Secretary for LRP participants. The forms utilized by each LRP include the following: the NHSC LRP Application, the Authorization for Disclosure of Loan Information form, the Privacy Act Release Authorization form, and if applicable, the Verification of Disadvantaged Background form and the Private Practice Option form. The first four of the aforementioned NHSC LRP forms collect information that is needed for selecting participants and repaying qualifying educational loans. The Private Practice Option Form, is needed to collect information for all participants who have applied for that service option. NHSC-approved sites are health care facilities that provide comprehensive outpatient, ambulatory, primary health care services to populations residing in HPSAs. Related in-patient services may be provided by NHSC-approved Critical Access Hospitals (CAHs) and Indian Health Service Hospitals. In order to become an NHSC-approved site, new sites must submit a Site Application for review and approval. Existing NHSC-approved sites are required to complete a Site Recertification Application in order to maintain their NHSC-approved status. Both the NHSC Site Application and Site Recertification Application request information on the clinical service site, sponsoring agency, recruitment contact, staffing levels, service users, charges for services, employment policies, and fiscal management capabilities. Assistance in completing these applications may be obtained through the appropriate State Primary Care Offices and the NHSC. The information collected on the applications is used for determining the eligibility of sites for the assignment of NHSC health professionals and to verify the need for NHSC clinicians. NHSC service site approval is valid for 3 years. Sites wishing to remain eligible for the assignment of NHSC providers must submit a Site Recertification Application every 3 years.

The latest form for The National Health Service Corps (NHSC) Loan Repayment Programs expires 2023-03-31 and can be found here.

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Revision of a currently approved collection 2023-01-18
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No material or nonsubstantive change to a currently approved collection 2020-04-21
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No material or nonsubstantive change to a currently approved collection 2018-09-06
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No material or nonsubstantive change to a currently approved collection 2016-09-29
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Revision of a currently approved collection 2013-11-22
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Extension without change of a currently approved collection 2010-11-23
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No material or nonsubstantive change to a currently approved collection 2009-06-02
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Approved with change
Revision of a currently approved collection 2005-07-06
Withdrawn and continue
Revision of a currently approved collection 2005-04-18
Approved without change
Extension without change of a currently approved collection 2002-02-28
Approved without change
Revision of a currently approved collection 1998-11-02
Approved without change
Revision of a currently approved collection 1995-06-21
Approved without change
Revision of a currently approved collection 1992-02-05
Approved without change
Revision of a currently approved collection 1991-01-30
Approved without change
New collection (Request for a new OMB Control Number) 1988-04-22
OMB Details

The National Health Service Corps (NHSC) Loan Repayment Program Application

Federal Enterprise Architecture: Health - Health Care Services

Form 1FY 2020 Combined Application Content DRAFT.pdf Fillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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