SELRP - Participant Agreement

Specialty Education Loan Repayment Program (SELRP) Forms [AQ63]

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0879 can be found here:

Documents and Forms

Document Name Document Type
Form 10-XXX SELRP - Participant Agreement Form
10-XXX Specialty Education Loan Repayment Program (SELRP) - Par 10-XXX_SELRP - Participant Agreement.pdf Form

Information Collection (IC) Details

IC Title:	SELRP - Participant Agreement	Agency IC Tracking Number:	2900-NEW

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 17

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-XXX	Specialty Education Loan Repayment Program (SELRP) - Participant Agreement	10-XXX_SELRP - Participant Agreement.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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