5-4 NC LRP COI 4-Submitted Landing Page - Revised

OMB Number: 0915-0140

Expiration Date: 5/31/2020

Public Burden Statement:

The purpose of the Nurse Corps Loan Repayment Program (NURSE CORPS LRP) is to assist in the recruitment and retention of professional Registered Nurses (RNs) dedicated to working in health care facilities with a critical shortage of nurses or working as nurse faculty in eligible schools of nursing, by decreasing the economic barriers associated with pursuing careers at such critical shortage facilities or in academic nursing. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0140 and it is valid until XX/XX/202X. This information collection is required to obtain or retain a benefit (Section 846 of the Public Health Service Act, as amended (42 U.S.C. 297n). Public reporting burden for this collection of information is estimated to average xx hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.

Note: Anywhere the year 2019 is displayed will automatically update to year 2020 in the system. Please make updates to months and days as needed.

NURSE Corps Loan Repayment Program Application

Hello Hannah,

You have confirmed your intent to accept the 2019 Nurse Corps Loan Repayment Program award. We will review the information you submitted as part of your acceptance to ensure completeness and accuracy.

Please be patient during the final review process, as you will receive notification via email that your status has been updated and you should log into the application portal. Upon logging into the portal you will find an appropriate status update as well as any relevant confirmation documents.

If you have any questions, please contact the Call Center at 1-800-221-9393, Monday-Friday, 8 a.m. - 8 p.m. ET (except Federal holidays).

All awards will be made no later than September 30th, 2019.

Please keep your contact information accurate and up to date on the Account Setting page.

Your overall application status is: Accepted Award - Under Final Review

Your application ID is: 496935

VIEW YOUR SUBMITTED APPLICATION

Your Nurse Corps Loan Repayment Program signed contract

EMPLOYMENT VERIFICATIONS

Site Name Initiation Date Response Date Status

L.A. County Health Services--Hubert H. Humphrey 09/30/2019 09/30/2019 Complete

GENERAL SUPPORTING DOCUMENTS

Document Title Document Name Status

Authorization to Release Information Received

Curriculum Vitae/Resume Received

Proof of US Citizenship or US National; Lawful Permanent Resident Received

Additional Supporting Document Not Received

LOAN SUPPORTING DOCUMENTS

Servicing Lender & Account # Document Title Document File Status

Access Group 12345678 Required Loan Supporting Documents Received

EDUCATION SUPPORTING DOCUMENTS

School Document Title Document File Status

Virginia Commonwealth University - School of Nursing Official/Unofficial transcript Received