Faculty Loan Repayment Program Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0150 can be found here:

Documents and Forms

Document Name Document Type
Attachment B - FLRP Application User Guide.pdf Instruction
Attachment C - FLRP Application Program Guidance.pdf Instruction
1 Authorization to Release Information Form Attachment D - Authorization to Release Information Form.pdf Form and Instruction
2 Institution Loan Repayment Form Attachment E - Institution Loan Repayment Form.pdf Form and Instruction
3 FLRP Contract Form Attachment F - FLRP Contract Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Faculty Loan Repayment Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment B - FLRP Application User Guide.pdf	Yes	No	Printable Only
Instruction			Attachment C - FLRP Application Program Guidance.pdf	Yes	No	Printable Only
Form and Instruction	1	Authorization to Release Information Form	Attachment D - Authorization to Release Information Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Institution Loan Repayment Form	Attachment E - Institution Loan Repayment Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	FLRP Contract Form	Attachment F - FLRP Contract Form.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 222	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	222	-690	912
Annual IC Time Burden (Hours)	250	-434	684
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.