2 Aor - Hrsa 501 - Pcl

Health Professions Student Loan and Nursing Student Loan Programs - Forms

PCL AOR April 20 2012 - DSLS

Health Professions Student Loan and Nursing Student Loan Programs - Forms

OMB: 0915-0044

Document [docx]
Download: docx | pdf

FINANCIAL DATA



Shape1

1. Federal Agency and Organization Element to Which Report is Submitted

2. Federal Grant or Other Identifying Number Assigned by Federal Agency

3a. DUNS #


4. Reporting Period End Date

Health Resources and Services Administration (HRSA)

Grant #:
Submission Tracking #:
OPSID:

3b. EIN


06/30/2012

PAGE 1A - STUDENT BORROWER DATA SECTION


Student/Graduate Data

Cumulative
(Includes current year)

Current Year
(7/1/2011-6/30/2012)

1A-1. Number of Loans for the Allopathic Medicine discipline

   


1A-2. Total Dollar Amount of Loans Awarded for the Allopathic Medicine discipline



1A-3. Total Full-Time Enrollment for the Allopathic Medicine discipline for the academic year (both non-PCL and PCL recipients)


  

1A-4a. Total Number of Defaulted Loans (HSPL -Allopathic Medicine and PCL -Allopathic Medicine)

   

   

1A-4b. Of the total number of defaulted loans above in question 1A-4a, how many are PCLs?


   

1A-4c. Of the total number of defaulted loans above in question 1A-4a, how many are HPSLs?


   

1A-5. Total Original Defaulted Principal Loaned for the Allopathic Medicine discipline


1A-6a. Total Number of Students (PCL recipients and non-recipients) who dropped out of the Allopathic Medicine discipline


   

1A-6b. Of the number above, how many of them were PCL student borrowers


   

1A-7. Total Number of Service Defaulted Borrowers for the Allopathic Medicine discipline
(Individuals not number of loans)

   

   
(Number of borrowers by year)

1A-8a. Total Number of HPSL and PCL Borrowers for the Allopathic Medicine discipline


(Shows both HPSL and PCL allopathic recipients)

Pre-populated from 1A-8b

1A-8b. Of the total number of borrowers above in question 1A-8a, how many are PCL borrowers with service requirements?



(Number of new PCL recipients)      

1A-8c. Of the number of PCL borrowers for the Allopathic Medicine discipline above in 1A-8b, number of Active and Non Retired/Defaulted Borrowers

   


1A-9. Total Number of PCL students including those who graduated during the reporting period for the Allopathic Medicine discipline

   



(Age and Gender details)

1A-10. Total Graduates (PCL-Allopathic Medicine Only)




1A-11. Number of PCL loan students including those who graduated during this reporting period that indicate an intention to serve in a medically underserved community.




1A-12. Number of PCL students and graduates during this reporting period from rural backgrounds.




Current Year Graduate Special Data

Number of Graduates

1A-13. Total number of full time Underrepresented Minority (URM) graduates during the current reporting period at your school.


1A-14. Total number of full time PCL graduates during the current reporting period who indicate an intention to work in rural areas.



Prior Years Graduate Special Data

Number of Graduates

1A-15a. Total Number of PCL - Allopathic Medicine Loan Recipients who graduated in academic year 2007-2008.


1A-15b. Of the Total Graduates reported in question 1A-15a, the Number of Full-Time PCL - Allopathic Medicine Graduates in academic year 2007-2008 serving in Medically Underserved Communities


1A-15c. Of the Total Graduates reported in question 1A-15a, the Number of Full-Time PCL - Allopathic Medicine Graduates in academic year 2007-2008 serving in Primary Care


1A-15d. Of the Total Graduates reported in question 1A-15a, the Number of Full-Time PCL-Allopathic Medicine Graduates in academic year 2007-2008 serving in a Rural Area.





Student/Graduate Data

Academic Year

Cumulative from 1993 to
AY 2007 - 2008

2006 - 2007

2007 - 2008

1A-16. Total Graduates (Allopathic Medicine Only)




1A-17. Of the number above, the number of Graduates in Primary Care Residencies & Practice




1A-18. Percentage of Graduates in Primary Health Care

    

    


1A-19. Percentage Change from Prior Year

    

    


OMB No.:0915-0044
Expiration Date:






















FINANCIAL DATA



Shape2


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 1b - Student Race/Ethnicity Data Section

FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

OPSID

Grant Number

Reporting Period




07/01/2011 - 06/30/2012


1. Hispanic or Latino Students

Did your BHPr funded program have students of "Hispanic or Latino ethnicity" between 7/1/2011 and 6/30/2012?

Hispanic or Latino Students by Race

Enrollment of Discipline
(A)

New Student Recipients
(B)

Recipients Other Than New Who Did Not Graduate
(C)

Recipients Other Than New Who Graduated
(D)

Total
Recipients
(B+C+D)

A. American Indian or Alaska Native






B. Asian - All (including underrepresented)






    B1. Asian - underrepresented, if Known





C. Black or African American






D. Native Hawaiian or Other Pacific Islander






E. White






F. More than one race
(Race combinations)






TOTAL (A + B + C + D + E + F)






Hispanic or Latino Students All Races

Enrollment of Discipline
(A)

New Student Recipients
(B)

Recipients Other Than New Who Did Not Graduate
(C)

Recipients Other Than New Who Graduated
(D)

Total
Recipients
(B+C+D)

G. All races







2. Non-Hispanic or Non-Latino Students

Did your BHPr funded program have students of "Non-Hispanic or Non-Latino ethnicity" between 7/1/2011 and 6/30/2012?

Non-Hispanic or Non-Latino Students by Race

Enrollment of Discipline
(A)

New Student Recipients
(B)

Recipients Other Than New Who Did Not Graduate
(C)

Recipients Other Than New Who Graduated
(D)

Total
Recipients
(B+C+D)

A. American Indian or Alaska Native






B. Asian - All (including underrepresented)






    B1. Asian - underrepresented, if known






C. Black or African American






D. Native Hawaiian or Other Pacific Islander






E. White






F. More than one race
(Race combinations)






TOTAL (A + B + C + D + E + F)






Non-Hispanic or Non-Latino Students All Races

Enrollment of Discipline
(A)

New Student Recipients
(B)

Recipients Other Than New Who Did Not Graduate
(C)

Recipients Other Than New Who Graduated
(D)

Total
Recipients
(B+C+D)

G. All races






OMB No.:0915-0044
Expiration Date:






FINANCIAL DATA





Shape3


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 2 - PROGRAMS ACCOUNT SECTION

FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

OPSID

Grant Number

Reporting Period




07/01/2011 - 06/30/2012


Program Accounts

Cumulative
(includes current year)

Current Year

A.

FEDERAL FUNDS AWARDED








B.

CASH BALANCE - START OF REPORT PERIOD







C.

CASH RECEIPTS



1.

Federal Funds Received/Receivable








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





11.

Cash Receipts Total (sum of C.1 through C.10)




D.

CASH DISBURSEMENTS



1.

Loaned to Students






2.

Transferred to Scholarship Fund





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






15.

Cash Disbursements Total (sum of D.1 through D.14)




E.

CASH BALANCE - END OF REPORT PERIOD
(CASH BALANCE START OF REPORT PERIOD + CASH RECEIPTS - CASH DISBURSEMENTS)







OMB No.:0915-0044
Expiration Date:














FINANCIAL DATA



Shape4


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 3 - PROGRAMS ACCOUNT SECTION (Continued)

FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

OPSID

Grant Number

Reporting Period




07/01/2011 - 06/30/2012


Program Accounts (Continued)

Cumulative
(includes current year)

Current Year

F.

LOAN CANCELLATIONS TO BORROWERS

Number of Borrowers

Principal

Interest

Number of Borrowers

Principal

Interest


1.

Professional Practice




a.

HP Practice-Shortage (10%)










b.

HP Practice-Rural Shortage (15%)











c.

Total (Sum of 1.a and 1.b)









2.

Nursing Employment




a.

Nursing Employment (10%)










b.

Nursing Employment (15%)










c.

Nursing Employment (20%)










d.

Nursing Employment (15%) on or after 03/23/2010










e.

Nursing Employment (20%) on or after 03/23/2010










f.

Nursing Employment (Other) on or after 03/23/2010










g.

Total (sum of 2.a through 2.f)









3.

Death




a.

On PCL Loans made on or after 10/22/85










b.

On Loans except those reported in F.3.a










c.

Total (Sum of 3.a and 3.b)









4.

Permanent & Total Disability Approved by HHS



a.

On PCL Loans made on or after 10/22/85










b.

On Loans except those reported in F.4.a










c.

Total (Sum of 4.a and 4.b)











PROGRAM ACCOUNTS (Continued)

Cumulative
(includes current year)

Current Year

G.

BAD DEBTS APPROVED FOR WRITE-OFF BY HHS

Number of Borrowers

Principal

Interest

Penalty Charges

Number of Borrowers

Principal

Interest

Penalty Charges


Total Approved














DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 4 - EXCESS CASH WORKSHEET

FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

OPSID

Grant Number

Reporting Period




07/01/2011 - 06/30/2012


A.

General Ledger Cash Balance as of 6/30/2011



B.

Actual Collections for 7/1/2011 - 6/30/2012


1.

Principal




2.

Interest




3.

Investment Income and Penalty Charges




4.

Institutional Repayments of Bad Debts (Principal, Interest & Penalty Charges)




C.

Federal Funds Received/Receivable 7/1/2011 - 6/30/2012




D.

Institutional Contribution for 7/1/2011 - 6/30/2012




E.

Projected Collections for 7/1/2012 - 6/30/2013


1.

Principal




2.

Interest




3.

Investment Income and Penalty Charges



F.

Projected Funds Available as of 6/30/2013 (A + B + C + D + E)



G.

Actual Expenditures for 7/1/2011 - 6/30/2012


1.

Loans to Students




2.

Costs (Collection, Litigation, Credit Bureau and Other)




3.

Repayments to Federal Government and Institution (Principal, Interest and Other Income)



H.

Projected Expenditures for 7/1/2012 - 6/30/2013


1.

Loans to Students




2.

Costs (Collection, Litigation and Credit Bureau)



I.

Projected Expenditures as of 6/30/2013 (G + H)



J.

Projected Cash Balance as of 6/30/2013 (F - I)



K.

Less Projected Expenditures for 7/1/2013 - 6/30/2015



L.

Excess Cash (J - K)



M.

General Ledger Ending Cash Balance as of 6/30/2012








OMB No.:0915-0044
Expiration Date:

















FINANCIAL DATA



Shape5


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 5 - PROGRAMS ACCOUNT SECTION (Continued)

FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

OPSID

Grant Number

Reporting Period



07/01/2011 - 06/30/2012


Program Accounts (Continued)

H.

FROM WORKSHEET CALCULATIONS



1.

Default Rate




FOR ACTIVE SCHOOLS



2.

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




3.

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




FOR CLOSING SCHOOLS



4.

Amount of cash determined to be due the Federal Government and remitted separately to the Division of Financial Operations





I.

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?





a. Period of last audit





b. Date audit submitted to Regional Audit Agency

















FINANCIAL DATA



Shape6


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 6a - BORROWER ACCOUNTS WORKSHEET

FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

OPSID

Grant Number

Reporting Period




07/01/2011 - 06/30/2012


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






G.

Total (sum of 1.A through 1.F)





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







G.

Total (sum of 2.A through 2.F)





3.

IN BANKRUPTCY


A.

Pending Discharge/Wage Earners Agreement






4.

IN DEFAULT


A.

120 Days and Over






5.

FORBEARANCE


A.

Forbearance







TOTAL












FINANCIAL DATA





Shape7



DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 6b - BORROWER ACCOUNTS WORKSHEET

FOR HRSA USE ONLY



Institution

Program




PCL - Allopathic Medicine



Submission Tracking Number

OPSID

Grant Number

Reporting Period






07/01/2011 - 06/30/2012


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






G.

Total (sum of 1.A through 1.F)





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







G.

Total (sum of 2.A through 2.F)





3.

IN BANKRUPTCY


A.

Pending Discharge/Wage Earners Agreement





4.

IN DEFAULT


A.

120 Days and Over






5.

FORBEARANCE


A.

Forbearance







TOTAL







OMB No.:0915-0044
Expiration Date:















FINANCIAL DATA



Shape8


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS

Annual Operating Report

Page 6c - BORROWER ACCOUNTS WORKSHEET

FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

OPSID

Grant Number

Reporting Period




07/01/2011 - 06/30/20112


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







G.

Total (sum of 1.A through 1.F)






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








G.

Total (sum of 2.A through 2.F)






3.

IN BANKRUPTCY


A.

Pending Discharge/Wage Earners Agreement






4.

IN DEFAULT


A.

120 Days and Over







5.

Forbearance



A.

Forbearance






TOTAL








OMB No.:0915-0044
Expiration Date:
































COMMENTS AND CERTIFICATION



Shape9


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

BUREAU OF HEALTH PROFESSIONS


FOR HRSA USE ONLY

Institution

Program


PCL - Allopathic Medicine

Submission Tracking Number

Grant Number

Reporting Period



07/01/2011 - 06/30/2012


1. Facility
(Name and complete address, including ZIP code)



2. Contact Information

Primary Point Of Contact



Alternate Point Of Contact



Certification: I certify to the best of my knowledge and belief that this Annual Operating report is true and correct.

Typed or Printed Name and Title

Telephone (Area code, number and extension)

Signature of Authorized Certifying Official

Date Report Submitted


Comments
















File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBradley Buckley
File Modified0000-00-00
File Created2021-01-30

© 2024 OMB.report | Privacy Policy