The National Health Service Corps (NHSC) Loan Repayment Program

Forms and Documents

Document Name	Status
Form nhsc lrp The National Health Service Corps (NHSC) Loan Repayment Program Form	Modified
Form lrp loan form 0127 NHSC Lender Form	New
Form lrp checklist 0127 NHSC Checklist Form	New
Form lfp release inform 0127 NHSC Authorization to Release Information Form Form	New
Form lrp verification 0127 NHSC Loan Information and Verification Form Form	New
Form lrp community site 0127 NHSC Community Site Information Form Form	New
ss 0127 2007 july.wpd Supporting Statement A	2007-07-30

IC Document Collections

IC ID	Document Title	Status
6365	The National Health Service Corps (NHSC) Loan Repayment Program Form	Modified
181470	0127 NHSC Lender Form	New
181469	0127 NHSC Checklist Form	New
181468	0127 NHSC Authorization to Release Information Form Form	New
181467	0127 NHSC Loan Information and Verification Form Form	New
181466	0127 NHSC Community Site Information Form Form	New

ICR Details

OMB Control No: 0915-0127	ICR Reference No: 200708-0915-002
Status: Historical Active	Previous ICR Reference No: 200507-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The National Health Service Corps (NHSC) Loan Repayment Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/25/2007
	Date Received in OIRA: 08/07/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2010	36 Months From Approved	10/31/2007
Responses	13,520	0	1,500
Time Burden (Hours)	3,476	0	2,163
Cost Burden (Dollars)	0	0	0

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Abstract: 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. Under this program, HHS agrees to repay the educational loans of the primary health care professionals. In return, the health professionals agree to service for a specified period of time in a federally designated HPSA approved by the Secretary for LRP participants.

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Authorizing Statute(s): PL: Pub.L. 107 - 205 846 Name of Law: Nurse Reinvestment Act
   US Code: 42 USC 2541 Name of Law: NHSC Scholarship Program and Loan Repayment Program
   PL: Pub.L. 107 - 205 836h Name of Law: National Education Loan Repayment Program
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 20346	04/24/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 41335	07/27/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
0127 NHSC Authorization to Release Information Form	lfp release information	lrp release information
0127 NHSC Checklist	lrp checklist	lrp checklist
0127 NHSC Lender	lrp loan form	lrp loan form
The National Health Service Corps (NHSC) Loan Repayment Program	nhsc lrp	nhsc lrp
0127 NHSC Community Site Information Form	lrp community site form	lrp community site form
0127 NHSC Loan Information and Verification Form	lrp verification	lrp verification

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ICR Summary of Burden

	Total Approved	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	13,520	1,500	0	0	12,020	0
Annual Time Burden (Hours)	3,476	2,163	0	0	1,313	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/06/2007

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