NURSE Corps Loan Repayment Program

ICR 202301-0915-001

OMB: 0915-0140

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0915-0140 can be found here:

2025-08-13 - Revision of a currently approved collection

Forms and Documents

Document Name	Status
Form 1 NURSE Corps LRP Application Form and Instruction	Modified
Form 1 Nurse Corps Nurse Faculty Employment Verification Form Form and Instruction	Modified
Form 2 Nurse Corps Crtiical Shortage Facility (CSF) Verification Form Form and Instruction	Modified
Form 3 Participant Semi-Annual in Service Verification Form Form and Instruction	Modified
Form 4 Confirmation of Interest Form Form and Instruction	Modified
Form 5 Disadvantaged Background Form Form and Instruction	Modified
Form 6 Authorization to Release Information Form Form and Instruction	Modified
Form 7 Employment Verification Form Form and Instruction	Modified
NC LRP - Supporting Statement A.docx Supporting Statement A	2023-01-05

IC Document Collections

IC ID	Document Title	Status
6368	NURSE Corps LRP Application Form and Instruction	Modified
239781	Nurse Corps Nurse Faculty Employment Verification Form Form and Instruction	Modified
239779	Nurse Corps Crtiical Shortage Facility (CSF) Verification Form Form and Instruction	Modified
239777	Participant Semi-Annual in Service Verification Form Form and Instruction	Modified
239776	Confirmation of Interest Form Form and Instruction	Modified
239775	Disadvantaged Background Form Form and Instruction	Modified
239774	Authorization to Release Information Form Form and Instruction	Modified
182803	Employment Verification Form Form and Instruction	Modified

ICR Details

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