NURSE Corps Loan Repayment Program

OMB 0915-0140

The need and purpose of this information collection is to obtain information for Nurse Corps LRP applicants and participants. The information is used to consider an applicant for a Nurse Corps LRP contract award, and to monitor a participant’s compliance with the service requirements. Individuals must submit an application in order to participate in the program. The application asks for personal, professional, educational, and financial information required to determine the applicant's eligibility to participate in the Nurse Corps LRP. The semi-annual employment verification form asks for personal and employment information to determine if a participant is in compliance with the service requirements. Respondents include professional RNs or advanced practice RNs (i.e., nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives, clinical nurse -0ecialists) who are interested in participating in the Nurse Corps LRP, and official representatives at their service sites.

The latest form for NURSE Corps Loan Repayment Program expires 2023-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

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

All Historical Document Collections

202301-0915-001 Approved without change	Extension without change of a currently approved collection	2023-01-05
202212-0915-001 Improperly submitted and continue	Extension without change of a currently approved collection	2022-12-27
202002-0915-001 Approved with change	Revision of a currently approved collection	2020-02-05
201812-0915-001 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2018-12-18
201804-0915-004 Approved without change	Revision of a currently approved collection	2018-04-25
201704-0915-005 Approved without change	Revision of a currently approved collection	2017-04-13
201609-0915-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-09-29
201403-0915-003 Approved with change	Revision of a currently approved collection	2014-03-17
201101-0915-001 Approved without change	Revision of a currently approved collection	2011-01-25
200902-0915-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2009-02-27
200711-0915-003 Approved without change	Revision of a currently approved collection	2007-11-20
200406-0915-003 Approved with change	Revision of a currently approved collection	2004-06-23
200102-0915-001 Approved without change	Revision of a currently approved collection	2001-02-08
199711-0915-003 Approved without change	Revision of a currently approved collection	1997-11-12
199409-0915-002 Approved without change	Revision of a currently approved collection	1994-09-26
199104-0915-001 Approved without change	Extension without change of a currently approved collection	1991-04-10
199006-0915-002 Approved without change	New collection (Request for a new OMB Control Number)	1990-06-14

OMB Details

NURSE Corps LRP Application

Federal Enterprise Architecture: Health - Health Care Services

Form 1

NC LRP - Application Form - Revised.docx

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.