The Nursing Education Loan Repayment Program

Forms and Documents

Document Name	Status
Form 1 The Nursing Education Loan Repayment Program Application Form	Modified
Form 7 Participant Semi-Annual Employment Verification Form Form	New
Form 6 Pre-Award Script Form	New
Form 2 Loan Verification Form Form	New
TOfClearancememo.doc Supplementary Document	2007-11-15
FINALSupporting Statement.doc Supporting Statement A	2007-11-15

IC Document Collections

IC ID	Document Title	Status
6368	The Nursing Education Loan Repayment Program Application Form	Modified
182803	Participant Semi-Annual Employment Verification Form Form	New
182802	Pre-Award Script Form	New
182801	Application Checklist	New
182800	Direct Deposit Sign-up Form	New
182799	Applicant Employment Verification Form	New
182798	Loan Verification Form Form	New

ICR Details

OMB Control No: 0915-0140	ICR Reference No: 200711-0915-003
Status: Historical Active	Previous ICR Reference No: 200406-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The Nursing Education Loan Repayment Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/17/2008
	Date Received in OIRA: 11/20/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	01/31/2008
Responses	38,200	0	9,200
Time Burden (Hours)	29,800	0	54,000
Cost Burden (Dollars)	0	0	0

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Abstract: Approval is requested for the application and monitoring forms for the Nursing Education Loan Repayment Program (NELRP). Under the NELRP, registered nurses are offered the opportunity to enter into a contractual agreement to receive loan repayment for some of their qualifying education loan balances. This repayment is in exchange for agreeing to servie full-time as a registered nurse for 2-3 years at a health care facilitiy with a critical shortage of nurses.

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Authorizing Statute(s): US Code: 42 USC 297n Name of Law: Public Health Service Act
  

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 33233	06/15/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 60379	10/24/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Participant Semi-Annual Employment Verification Form	7	Emp Verification Form
Application Checklist
Pre-Award Script	6	Pre-Award Script
The Nursing Education Loan Repayment Program Application	1	Application
Loan Verification Form	2	Loan Verification Form
Applicant Employment Verification Form
Direct Deposit Sign-up Form

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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	38,200	9,200	0	0	29,000	0
Annual Time Burden (Hours)	29,800	54,000	0	0	-24,200	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: $837,294

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: 11/20/2007

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