Initital Extramural Applicants

National Institutes of Health Loan Repayment Programs

Documents and Forms

Document Name Document Type
Form 1 Initital Extramural Applicants Form and Instruction
1 Applicant Applicant 07-27-2022.pdf Form and Instruction
1 Applicant Applicant 07-27-2022.pdf Form and Instruction
Eligibilty - HD with burden statement.pdf Eligibility - Health Disparities (HD) IC Document
Eligibilty - HD with burden statement.pdf Eligibility - Health Disparities (HD) IC Document

Information Collection (IC) Details

IC Title:	Initital Extramural Applicants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Applicant	Applicant 07-27-2022.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: DHHS 09-25-0165 National Institutes of Health (NIH) Office of Loan Repayment and Scholarship (OLRPS) Record System, HHS/NIH/OD	FR Citation: 67 FR 60742

Number of Respondents: 1,300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,300	-350	1,650
Annual IC Time Burden (Hours)	10,400	-2,800	13,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Eligibility - Health Disparities (HD)	Eligibilty - HD with burden statement.pdf	08/15/2019

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