Faculty Loan Repayment Program

ICR 202101-0915-001

OMB: 0915-0150

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2021-01-15
IC Document Collections
ICR Details
0915-0150 202101-0915-001
Received in OIRA 201806-0915-002
HHS/HSA
Faculty Loan Repayment Program
Revision of a currently approved collection   No
Regular 01/19/2021
  Requested Previously Approved
36 Months From Approved 08/31/2021
744 222
456 250
0 0

The need and purpose of this information collection is to obtain information to consider applicants for a Faculty Loan Repayment Program contract award. Applicants must submit a Disadvantaged Background Form as a requirement of the application to determine the applicant’s eligibility to participate in the program and competitiveness in rank for award funding. Respondents include individuals who have a health professions degree or certificate to serve as faculty members in eligible, accredited health professions schools.

PL: Pub.L. 105 - 392 738(a) Name of Law: Health Professions Education Partnerships Act of 1998
   US Code: 42 USC 293b Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  85 FR 63120 10/06/2020
86 FR 4099 01/15/2021
No

  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 744 222 0 522 0 0
Annual Time Burden (Hours) 456 250 0 206 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The increase in burden is due to an increase in estimated responses and the addition of the Disadvantaged Background form to this information collection request.

$201,372
No
    Yes
    Yes
No
No
No
No
Elyana Bowman 301 443-3983 enadjem@hrsa.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.
01/19/2021


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