501c Annual Operating Report-Closing programs

OMB No. 0915-0044

Expires:

Name

1st Address

2nd Address

City, State Zip Code

Program:

FEDERAL CAPITAL CONTRIBUTION

HEALTH PROFESSIONS STUDENT LOANS, PRIMARY CARE LOANS, LOANS FOR DISADVANTAGED STUDENTS, AND NURSING STUDENT LOANS - CLOSING

ANNUAL OPERATING REPORT

FOR THE PERIOD JULY 1, XXXX THROUGH JUNE 30, XXXX

Please read the instructions before you begin to fill out the report or before calling for assistance.

If this report is to be prepared by someone in another office, please be sure this packet is kept intact for that individual’s knowledge and use.

PUBLIC REPORTING BURDEN STATEMENT

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-0044. Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland 20857.

HRSA-501 Page 2

Worksheet for all Closing Health Professions Student Loans (HPSL), Primary Care Loans (PCL), Loans for Disadvantaged Students (LDS), and Nursing Student Loans (NSL)

DATE: MM/DD/YY OPS NO.

INSTITUTION:

SCHOOL:

PROGRAM:

ANNUAL OPERATING REPORT: JULY 1, 20XX - JUNE 30, 20XX

STUDENT LOAN PROGRAM - CLOSING

PROGRAM ACCOUNTS SECTION

PROGRAM ACCOUNTS			Cumulative	Current Year
A.	FEDERAL FUNDS AWARDED			XXXXXXXX
B.	CASH BALANCE - START OF REPORT PERIOD		XXXXXXXX
C.	CASH RECEIPTS
	1.	Federal Funds Received/Receivable		XXXXXXXX
	2.	Institutional Contributions Deposited
	3.	Transferred from Scholarship Fund
	4.	Loan Principal Collected
	5.	Interest Income Collected on Loans
	6.	Penalty Charges Collected on Loans
	7.	Investment Income
	8.	Institutional Repayments of Bad Debts, Principal
	9.	Institutional Repayments of Bad Debts, Interest
	10.	Institutional Repayments of Bad Debts, Penalty Charges
D.	CASH DISBURSEMENTS
	1.	Loaned to Students		XXXXXXXX
	2.	Transferred to Scholarship Fund		XXXXXXXX
	3.	Repayments to Federal Government, Principal
	4.	Repayments to Federal Government, Interest
	5.	Repayments to Federal Government, Other Income
	6.	Repayments to Institution, Principal
	7.	Repayments to Institution, Interest
	8.	Repayments to Institution, Other Income
	9.	Collection Agent Costs, Principal
	10.	Collection Agent Costs, Interest
	11.	Litigation Costs, Principal
	12.	Litigation Costs, Interest
	13.	Credit Bureau Fees
	14.	Other Costs (Overpayments & Underpayments)
E.	CASH BALANCE END OF REPORT PERIOD		XXXXXXXX

HRSA-501 Page 3

Worksheet for all Active and Closing Health Professions Student Loans (HPSL), Primary Care Loans (PCL), Loans for Disadvantaged Students (LDS), and Nursing Student Loans (NSL)

DATE: MM/DD/YY OPS NO.

INSTITUTION:

SCHOOL:

PROGRAM:

ANNUAL OPERATING REPORT: JULY 1, 20XX - JUNE 30, 20XX

STUDENT LOAN PROGRAM

PROGRAM ACCOUNTS SECTION (Continued)

PROGRAM ACCOUNTS (Continued)				Cumulative			Current Year
				Number of Borrowers	Principal	Interest	Number of Borrowers	Principal	Interest
F.	LOAN CANCELLATIONS TO BORROWERS
	1.	Professional Practice
		a.	HP Practice-Shortage (10%)
		b.	HP Practice-Rural Shortage (15%)
	2.	Nursing Employment
		a.	Nursing Employment (10%)	XXXXXX	XXXX	XXXX
		b.	Nursing Employment (15%)	XXXXXX	XXXX	XXXX
		c.	Nursing Employment (20%)	XXXXXX	XXXX	XXXX
	3.	Death
		a.	On HPSL Loans made on or after 10/22/85
		b.	On Loans except those reported in F.3.a.
	4.	Permanent & Total Disability Approved by HHS
		a.	On HPSL Loans made on or after 10/22/85
		b.	On Loans except those reported in F.4.a.

PROGRAM ACCOUNTS (Continued)		Cumulative				Current Year
H.		No. of Borrowers	Principal	Interest	Penalty Charges	No. of Borrowers	Principal	Interest	Penalty Charges
	BAD DEBTS APPROVED FOR WRITE-OFF BY HHS
	BAD DEBTS UNDER $3000 APPROVED FOR WRITE-OFF BY INST.
	Total Approved

HRSA-501 Page 5

Worksheet for all Closing Health Professions Student Loans (HPSL), Primary Care Loans (PCL), Loans for Disadvantaged Students (LDS), and Nursing Student Loans (NSL)

DATE: MM/DD/YY OPS NO.

INSTITUTION:

SCHOOL:

PROGRAM:

ANNUAL OPERATING REPORT: JULY 1, 20XX - JUNE 30, 20XX

STUDENT LOAN PROGRAM - CLOSING

PROGRAM ACCOUNTS SECTION (Continued)

J. FROM WORKSHEET CALCULATIONS

1. Default Rate ______________%

FOR ACTIVE SCHOOLS:

2. Excess Cash from report page 4 that was or will be returned to PMS XXXXXXXXX

3. Excess Cash from report page 4 that was or will be returned to the
Division of Financial Operations XXXXXXXXX

FOR CLOSING SCHOOLS

4. Amount of cash determined to be due the Federal Government and remitted separately

to the Division of Financial Operations ______________

K. CHECK LIST/QUESTIONS

1. What is the total amount of interest that is past due? ______________

AUDITS

2. Does your institution provide for a biennial audit of the loan and/or scholarship funds
by a qualified independent auditor? ___Y ___N ___N/A

a. Period of last audit ____/___to____/___

mon yr mon yr

b. Date audit submitted to Regional Audit Agency ____/___

MON YR

HRSA-501 Page 6a

Worksheet for all Active and Closing Health Professions Student Loans (HPSL), Primary Care Loans (PCL), Loans for Disadvantaged Students (LDS), and Nursing Student Loans (NSL)

DATE: MM/DD/YY OPS NO.

INSTITUTION:

SCHOOL:

PROGRAM:

STATUS OF ALL BORROWER ACCOUNTS AS OF JUNE 30, 20XX

STUDENT LOAN PROGRAM

BORROWER ACCOUNTS WORKSHEET

BORROWER ACCOUNTS			Number of Borrowers 1	Principal Loaned 2	Principal Repaid 3
1.	FULLY RETIRED
	A.	Repayment/Prof Pract/Cancel
	B.	Cancellation/Death
	C.	Cancellation/Disability
	D.	Discharged in Bankruptcy
	E.	HHS Approved Write-off
	F.	Uncollectible per P.L. 100-607
2.	CURRENT
	A.	Student Status
	B.	Grace Period
	C.	Deferment Status
	D.	Postponement/Cancellation
	E.	Repayment - Not Past Due
	F.	Past Due 1-119 Days
3.	IN BANKRUPTCY
	A.	Pending Discharge/Wage Earners Agreement
4.	IN DEFAULT
	A.	120 Days and Over
5.	FORBEARANCE
	A.	Forbearance
	TOTAL

HRSA-501 Page 6b

Worksheet for all Active and Closing Health Professions Student Loans (HPSL), Primary Care Loans (PCL), Loans for Disadvantaged Students (LDS), and Nursing Student Loans (NSL)

DATE: MM/DD/YY OPS NO.

INSTITUTION:

SCHOOL:

PROGRAM:

STATUS OF ALL BORROWER ACCOUNTS AS OF JUNE 30, 20XX

STUDENT LOAN PROGRAM

BORROWER ACCOUNTS WORKSHEET

BORROWER ACCOUNTS			PRINCIPAL CANCELED
			Employment/ Prof Pract 4	Death/ Disability 5	Principal Delinquent 6
1.	FULLY RETIRED
	A.	Repayment/Prof Pract/Cancel
	B.	Cancellation/Death
	C.	Cancellation/Disability
	D.	Discharged in Bankruptcy
	E.	HHS Approved Write-off
	F.	Uncollectible per P.L. 100-607
2.	CURRENT
	A.	Student Status
	B.	Grace Period
	C.	Deferment Status
	D.	Postponement/Cancellation
	E.	Repayment - Not Past Due
	F.	Past Due 1-119 Days
3.	IN BANKRUPTCY
	A.	Pending Discharge/Wage Earners Agreement
4.	IN DEFAULT
	A.	120 Days and Over
5.	FORBEARANCE
	A.	Forbearance
	TOTAL

HRSA-501 Page 6c

Worksheet for all Active and Closing Health Professions Student Loans (HPSL), Primary Care Loans (PCL), Loans for Disadvantaged Students (LDS), and Nursing Student Loans (NSL)

DATE: MM/DD/YY OPS NO.

INSTITUTION:

SCHOOL:

PROGRAM:

STATUS OF ALL BORROWER ACCOUNTS AS OF JUNE 30, 2006

STUDENT LOAN PROGRAM

BORROWER ACCOUNTS WORKSHEET

BORROWER ACCOUNTS			Principal Uncollectible Not Past Due 7	Principal Outstanding but Not Due 8	Principal Written Off 9	Capitalized Interest 10
1.	FULLY RETIRED
	A.	Repayment/Prof Pract/Cancel
	B.	Cancellation/Death
	C.	Cancellation/Disability
	D.	Discharged in Bankruptcy
	E.	HHS Approved Write-off
	F.	Uncollectible per P.L. 100-607
2.	CURRENT
	A.	Student Status
	B.	Grace Period
	C.	Deferment Status
	D.	Postponement/Cancellation
	E.	Repayment - Not Past Due
	F.	Past Due 1-119 Days
3.	IN BANKRUPTCY
	A.	Pending Discharge/Wage Earners Agreement
4.	IN DEFAULT
	A.	120 Days and Over
5.	FORBEARANCE
	A.	Forbearance
	TOTAL