OMB control number

NURSE Corps Loan Repayment Program

OMB 0915-0140 · HHS/HSA.

OMB 0915-0140

The need and purpose of this information collection is to obtain information for Nurse Corps LRP applicants and participants. The information is used to consider an applicant for a Nurse Corps LRP contract award, and to monitor a participant’s compliance with the service requirements. Individuals must submit an application in order to participate in the program. The application asks for personal, professional, educational, and financial information required to determine the applicant's eligibility to participate in the Nurse Corps LRP. The semi-annual employment verification form asks for personal and employment information to determine if a participant is in compliance with the service requirements. Respondents include professional RNs or advanced practice RNs (i.e., nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives, clinical nurse -0ecialists) who are interested in participating in the Nurse Corps LRP, and official representatives at their service sites.

The latest form for NURSE Corps Loan Repayment Program expires 2028-11-30 and is listed under ICR 202508-0915-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 8 LRP Application User Guide	Form and Instruction
Form 8 NURSE Corps LRP Application	Form and Instruction
Form 1 Nurse Corps Nurse Faculty Employment Verification Form	Form and Instruction
Form 1 Nurse Corps Nurse Faculty Employment Verification Form	Form and Instruction
Form 2 NC LRP Employment Verification Form	Form and Instruction
Form 2 Nurse Corps Crtiical Shortage Facility (CSF) Verification Form	Form and Instruction
Form 3 Participant Semi-Annual In Service Verification Form	Form and Instruction
Form 3 Participant Semi-Annual in Service Verification Form	Form and Instruction
Form 4 Confirmation of Interest Form	Form and Instruction
Form 4 Confirmation of Interest Form	Form and Instruction
Form 5 Disadvantaged Background Form	Form and Instruction
Form 5 Disadvantaged Background Form	Form and Instruction
Form 6 NC LRD Authorization to Release Information Form	Form and Instruction
Form 6 Authorization to Release Information Form	Form and Instruction
Form 7 Employment Verification Form	Form and Instruction
Form 7 Employment Verification Form	Form and Instruction
NC LRP - Supporting Statement (09232025).docx	Supporting Statement A
NC LRP - Supporting Statement - Updated 7.30.25.docx	Supporting Statement A
NURSE Corps LRP Application	Form and Instruction
NURSE Corps LRP Application	Form and Instruction
Nurse Corps Nurse Faculty Employment Verification Form	Form and Instruction
Nurse Corps Nurse Faculty Employment Verification Form	Form and Instruction
Nurse Corps Crtiical Shortage Facility (CSF) Verification Form	Form and Instruction
Nurse Corps Crtiical Shortage Facility (CSF) Verification Form	Form and Instruction
Participant Semi-Annual in Service Verification Form	Form and Instruction
Participant Semi-Annual in Service Verification Form	Form and Instruction
Confirmation of Interest Form	Form and Instruction
Confirmation of Interest Form	Form and Instruction
Disadvantaged Background Form	Form and Instruction
Disadvantaged Background Form	Form and Instruction
Authorization to Release Information Form	Form and Instruction
Authorization to Release Information Form	Form and Instruction
Employment Verification Form	Form and Instruction
Employment Verification Form	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202508-0915-001	Revision of a currently approved collection	2025-08-13
202301-0915-001	Extension without change of a currently approved collection	2023-01-05	Approved without change
202212-0915-001	Extension without change of a currently approved collection	2022-12-27	Improperly submitted and continue
202002-0915-001	Revision of a currently approved collection	2020-02-05	Approved with change
201812-0915-001	No material or nonsubstantive change to a currently approved collection	2018-12-18	Improperly submitted and continue
201804-0915-004	Revision of a currently approved collection	2018-04-25	Approved without change
201704-0915-005	Revision of a currently approved collection	2017-04-13	Approved without change
201609-0915-006	No material or nonsubstantive change to a currently approved collection	2016-09-29	Approved without change
201403-0915-003	Revision of a currently approved collection	2014-03-17	Approved with change
201101-0915-001	Revision of a currently approved collection	2011-01-25	Approved without change
200902-0915-001	No material or nonsubstantive change to a currently approved collection	2009-02-27	Approved without change
200711-0915-003	Revision of a currently approved collection	2007-11-20	Approved without change
200406-0915-003	Revision of a currently approved collection	2004-06-23	Approved with change
200102-0915-001	Revision of a currently approved collection	2001-02-08	Approved without change
199711-0915-003	Revision of a currently approved collection	1997-11-12	Approved without change
199409-0915-002	Revision of a currently approved collection	1994-09-26	Approved without change
199104-0915-001	Extension without change of a currently approved collection	1991-04-10	Approved without change
199006-0915-002	New collection (Request for a new OMB Control Number)	1990-06-14	Approved without change

OMB Details

NURSE Corps LRP Application

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form 8	LRP Application User Guide	Fillable Fileable	Form and instruction

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