Indian Health Service Loan Repayment Program

ICR 201803-0917-002

OMB: 0917-0014

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2018-05-09
Supplementary Document
2015-06-22
Supplementary Document
2015-06-22
IC Document Collections
IC ID
Document
Title
Status
6573 Modified
ICR Details
0917-0014 201803-0917-002
Active 201506-0917-001
HHS/IHS 0917-0014
Indian Health Service Loan Repayment Program
Extension without change of a currently approved collection   No
Regular
Approved without change 11/23/2018
Retrieve Notice of Action (NOA) 05/09/2018
Before this ICR is renewed, please ensure a new consultation about the burden estimates and forms.
  Inventory as of this Action Requested Previously Approved
11/30/2021 36 Months From Approved 11/30/2018
1,999 0 816
2,999 0 1,224
0 0 0

The Indian Health Service (IHS) Loan Repayment Program (LRP) identifies health professionals with pre-existing financial obligations for education expenses that meet program criteria and who are qualified and willing to serve at, often remote, IHS health care facilities. Under the program, eligible health professionals sign a contract under which the IHS agrees to repay part or all of their indebtedness for professional training education. In exchange, the health professionals agree to serve for a specified period of time in IHS health care facilities. This information collection covers the application process for this program.

PL: Pub.L. 94 - 437 108 Name of Law: Indian Health Care Improvement Act, as amended
  
None

Not associated with rulemaking

  82 FR 55107 11/20/2017
83 FR 6601 02/14/2018
Yes

1
IC Title Form No. Form Name
IHS Loan Application 0917-0014, 0917-0014, 0917-0028 Educational and Professional Background ,   Financial Information ,   General Applicant Information

  Total Approved 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 1,999 816 0 1,183 0 0
Annual Time Burden (Hours) 2,999 1,224 0 1,775 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The estimated burden hours have increased due to the increase in respondents. Most Indian health program sites are eligible for the National Health Service Corps Loan Repayment Program. The number of applicants have increased due to eligible health professionals being recruited through the efforts of both programs.

$268,426
No
    Yes
    No
No
No
No
Uncollected
Evonne Bennett-Barnes 301 443-4750 evonne.bennett-barnes@ihs.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/09/2018


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