Nurse Faculty Loan Program Forms

Forms and Documents

Document Name	Status
Form 3 NFLP Due Diligence Form Form and Instruction	Modified
Form 2 Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form Form and Instruction	Modified
Form 1 Nurse Faculty Loan Program Forms- Program Specific Data Form Form and Instruction	Modified
Supporting Statement A – 0915-0314 - BHW-NFLP Form - Revision – 01092026.docx Supporting Statement A	2026-01-29

IC Document Collections

IC ID	Document Title	Status
260347	NFLP Due Diligence Form Form and Instruction	Modified
241796	Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form Form and Instruction	Modified
182194	Nurse Faculty Loan Program Forms- Program Specific Data Form Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0314	ICR Reference No: 202601-0915-002
Status: Received in OIRA	Previous ICR Reference No: 202308-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No: 21370
Title: Nurse Faculty Loan Program Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/29/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	317	317
Time Burden (Hours)	1,982	1,982
Cost Burden (Dollars)	0	0

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Abstract: The NFLP – Program Specific Data Form is a required electronic attachment within the NFLP application materials. The data provided in the form is essential for the formula-based criteria used to determine the award amount to the applicant schools. The form will collect application-related data from applicants such as the amount requested, number of students to be funded, tuition information, and projected unused loan fund balance. The NFLP-Annual Performance Report (APR) Financial Data Form is an online form that exists in the HRSA Electronic Handbooks (EHBs) Performance Report module. The NFLP-APR Financial Data Form collects outcome and financial data to capture the NFLP loan fund account activity related to financial receivables, disbursements, and borrower account data related to employment status, loan cancellation, loan repayment and collections. Participating schools will provide HHS with current and cumulative information on: (1) NFLP loan funds received, (2) number and amount of NFLP loans made, (3) number and amount of loans cancelled, (4) number and amount of loans in repayment, (5) loan default rate percent, (6) number of NFLP graduates employed as nurse faculty, and (7) other related loan fund costs and activities. The NFLP Due-Diligence Form is a required form to be completed and submitted electronically by NFLP award recipients. This form indicates that due diligence has been exercised in the cancellation of all or any remaining NFLP loan for NFLP borrowers in the event of permanent/total disability or death, or the write-off of all or any remaining payment of the NFLP loan as uncollectible/bad debt. The data provided on the form will verify the due diligence process the institution used for NFLP loan cancellations or uncollectible debt write-offs. Data collected on the due-diligence form is essential for HRSA to effectively monitor performance outcomes and verify the accuracy of the number and amount of NFLP loan funds cancelled and written off that is reported by NFLP award recipients during the Annual Performance Reporting period. The form will collect the student borrower’s unique ID, amount of loan funds cancelled/written off (principal plus interest), reason for cancellation/write-off, and institutional certification/due diligence process utilized.

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Authorizing Statute(s): US Code: 42 USC 297n-1, Section 846A Name of Law: Title VIII, PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 44199	09/12/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 3894	01/29/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
NFLP Due Diligence Form	3	NFLP Due Diligence Form
Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form	2	NFLP Annual Performance Report (APR) Financial Data Form
Nurse Faculty Loan Program Forms- Program Specific Data Form	1	NFLP Program Specific Data Form

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	317	317	0	0	0	0
Annual Time Burden (Hours)	1,982	1,982	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $16,208

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/29/2026

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