Form 2 Revolving Loans Generic AOR Wireframes

Health Professions Student Loan (HPSL) Program and Nursing Student Loan (NSL) Program: Administrative Requirements (Regulations & Policy)

FORM - Revolving Loans Generic AOR Wireframes

Health Professions Student Loan (HPSL) Program and Nursing Student Loan (NSL) Program: Administrative Requirements (Regs. & Policy)

OMB: 0915-0047

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Public Burden Statement: The purpose of this information collection request is to obtain information for the administrative requirements pertaining to the Health Professions Student Loan (HPSL), Loans for Disadvantaged Students (LDS), Primary Care Loan (PCL) and Nursing Student Loan Programs (NSL). Participating HPSL, LDS, PCL and NSL schools are responsible for determining eligibility of applicants making loans, and collecting monies owed by borrowers on their outstanding loans. 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 0915-0047 and it is valid until XX/XX/202X. This information collection is required to obtain or retain a benefit (HPSL – Sections 721-722 and 725-735 of the PHS Act; LDS – Sections 721-722 and 724-735 of the PHS Act; PCL – Sections 721-723 and 725-735 of the PHS Act; NSL – Sections 835-842 of the PHS Act). 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.

OMB #: 0915-0047

Expiration Date: xx/xx/202x





  1. Page 1A


Student/Graduate Data

Cumulative ($) (Previous Years)

Cumulative ($)
(Includes current year)

Current Year ($)
(
07/01/2020-06/30/2021)

1. Number of Loans for the <Discipline>

Prepopulated

Prepopulated


2. Total Dollar Amount of Loans Awarded for the <Discipline>

Prepopulated

Prepopulated


3. Total Full-Time Enrollment for the <Discipline> for the academic year (both non-HPSL and HPSL recipients)

Prepopulated

Prepopulated

4. Total Number of Defaulted Loans for the <Discipline>

Prepopulated

Prepopulated


5. Total Original Defaulted Principal Loaned for the <Discipline>

Prepopulated

Prepopulated

6a. Total Number of Students who dropped out of the <Discipline>

Prepopulated

Prepopulated


6b. Of the number above, how many of them were Health Careers Loans Branch student borrowers

Prepopulated

Prepopulated


7a. Total Number of Health Careers Loans Branch student borrowers for the <Discipline>

Prepopulated

Prepopulated


7b. Of the number of Health Careers Loans Branch student borrowers for the <Discipline> above, number of Active and Non Retired/Defaulted Borrowers

Prepopulated

Prepopulated and editable


8. Total Number of Health Careers Loans Students including those who graduated during the reporting period for the <Discipline> (Age and Gender details)

Prepopulated

Prepopulated


9. Total Graduates (HPSL- <Discipline> only)

Prepopulated

Prepopulated


10. Number of Health Careers Loans Branch students including those who graduated during this reporting period that indicate an intention to serve in a medically underserved community

Prepopulated

Prepopulated


11. Number of Health Careers Loans Branch students including those that graduated during this reporting period that indicate an intention to practice in primary care

Prepopulated

Prepopulated


12. Number of Health Careers Loans Branch students including those who graduated during this reporting period that are from rural backgrounds

Prepopulated

Prepopulated




Current Year Graduate Special Data

Number of Graduates

13. Total number of full time graduates (Health Career Loans recipients and Non-Health Careers Loans recipients) at your school during the current reporting period.


13a. Of the total number in question 1A-13, how many are URM graduates.


13b. Of the total number in question 1A-13, how many are non-URM graduates.


14. Total number of full time HPSL graduates during the current reporting period who indicate intent to serve in a rural area.




Prior Year Graduate Special Data for 2019-2020 Academic Year

Number of Graduates

15a. Total Number Recipients who graduated in academic year 2018-2019

0 – Warning: If number is zero, you must provide a justification.

15b. Of the Total Graduates reported in question 1A-15a, the Number of Full-Time and Half-Time Graduates in academic year 2019-2020 serving in Medically Underserved Communities

0 – Warning: If number is zero, you must provide a justification.

15c. Of the Total Graduates reported in question 1A-15a, the Number of Full-Time and Half-Time Graduates in academic year 2019-2020 serving in Primary Care


0 – Warning: If number is zero, you must provide a justification.

15d. Of the Total Graduates reported in question 1A-15a, the Number of Full-Time and Half-Time Graduates in academic year 2019-2020 who entered the field for which they received the degree


0 – Warning: If number is zero, you must provide a justification.

15e. Of the Total Graduates in question 1A-15a, the Number of Full-Time and Half-Time Graduates in academic year 2019-2020 who entered service in a rural area.


0 – Warning: If number is zero, you must provide a justification.

15f. Based on the graduates reported in 15e, what is the outstanding debt of the graduates in rural areas.

0 – Warning: If number is zero, you must provide a justification.



Student Special Data


16. Please indicate the recruitment activities for disadvantaged students your school uses for the LDS program by checking all box(s) that apply. (Recruitment Details)


16a. Are you a Community College.

The response will  be either Yes or No, provided by radio buttons or a drop down menu

16b. Are you a Historically Black College or University.

The response will  be either Yes or No, provided by radio buttons or a drop down menu

16c. Are you a Tribal Institution.

The response will  be either Yes or No, provided by radio buttons or a drop down menu

16d. Where is your institution located?

the response should be either Rural, Urban or Other, provided by radio buttons or a drop down menu

17a. Please indicate the retention and/or mentoring activities for disadvantaged students that your school uses for the LDS program by checking all boxes that apply. (Retention Details)


17b. Please indicate the type of retention and/or mentoring activities for disadvantaged students your school uses for the LDS program by checking all boxes that apply. (Type of Retention Activities Details)


18. Please share in the box below any success stories about LDS recipients. (Maximum 250 characters)




19. How many LDS students received pipeline training from other HRSA programs (i.e., Health Careers Opportunity Program (HCOP) Centers of Excellence (COE) at any period of time? (Data collection period starts July 1, 2011).


Description

Cumulative (Includes Current Year)

Current (New LDS Recipients)

HCOP

Pre-Populated


COE

Pre-Populated


Other


Pre-Populated


Other Program Titles

Pre-Populated




20. Please provide the name of at least one health clinic that provides service to a significant number of individuals who are from disadvantaged backgrounds including members of minority groups, that your school has an agreement with to provide students with experience in providing clinical services to such individuals. (Maximum 100 characters)

Clinic 1:


Clinic 2:


Clinic 3:




Student/Graduate Data

Academic Year

Cumulative (Previous Year)

Cumulative from 1993 to AY 2015-2016

2014-2015

2015-2016

21. Total Graduates (<Discipline> Only)

Pre-populated


Pre-populated

Pre-populated

22. Of the number above, the number of Graduates in Primary Care Residencies & Practice

Pre-populated


Pre-populated

Pre-populated

23. Percentage of Graduates in Primary Health Care

Pre-populated




24. Percentage of Change from Prior Year

Pre-populated





































  1. Page 1B

Hispanic or Latino Students By Race

Enrollment of Discipline

(A)

New Student Recipients

(B)

Recipients Other Than New Who Did Not Graduate

(C)

Recipients Other Than New Who Graduated

(D)

Total Recipients (B+C+D)

A. American Indian or Alaska Native






B. Asian






C. Black or African-American






D. Native Hawaiian or Other Pacific Islander






E. White






A. Hispanic or Latino






B. Race Not Reported






Total (A + B)








Non-Hispanic or Non-Latino Students By Race

Enrollment of Discipline

(A)

New Student Recipients

(B)

Recipients Other Than New Who Did Not Graduate

(C)

Recipients Other Than New Who Graduated

(D)

Total Recipients (B+C+D)

A. American Indian or Alaska Native






B. Asian






C. Black or African-American






D. Native Hawaiian or Other Pacific Islander






E. White






F. More than one race






G. Race Not Reported






Total (A + B + C + D + E + F + G)












  1. Page 2

Program Accounts Section

A. Federal Funds Awarded

Cumulative ($)

(Previous Year)

Cumulative ($)

(Includes Current Year)

Current Year ($)

1. Federal Funds Awarded

Prepopulated

Prepopulated

Prepopulated

B. Cash Balance – Start of Report Period



Current Year

1. Cash Balance – Start of Report Period


Prepopulated

2. Cash Balance – Start of Report Period Adjustment

.

This field is grayed out for grantee. This field is only available to POs to make adjustments

C. Cash Receipts

Cumulative ($)

(Previous Year)

Cumulative ($)

(Includes Current Year)

Current Year ($)

1. Federal Funds Received/Receivable

Prepopulated

Prepopulated


2. Institutional Contributions Deposited


Prepopulated

Prepopulated


3. Transferred from Scholarship Fund

Prepopulated

Prepopulated


4. Loan Principal Collected

Prepopulated

Prepopulated


5. Interest Income Collected on Loans

Prepopulated

Prepopulated


6. Penalty Charges Collected on Loans

Prepopulated

Prepopulated


7. Investment Income

Prepopulated

Prepopulated


8. Institutional Repayments of Bad Debts, Principal

Prepopulated

Prepopulated


9. Institutional Repayments of Bad Debts, Interest

Prepopulated

Prepopulated


10. Institutional Repayments of Bad Debts, Penalty charges

Prepopulated

Prepopulated


C. Total

Prepopulated

Prepopulated


D. Cash Disbursements




1. Loaned to Students

Prepopulated

Prepopulated


2. Transferred to Scholarship Fund

Prepopulated

Prepopulated


3. Repayments to Federal Government, Principal

Prepopulated

Prepopulated


4. Repayments to Federal Government, Interest

Prepopulated

Prepopulated


5. Repayments to Federal Government, Other Income

Prepopulated

Prepopulated


6. Repayments to Institution, Principal

Prepopulated

Prepopulated


7. Repayments to Institution, Interest

Prepopulated

Prepopulated


8. Repayments to Institution, Other Income

Prepopulated

Prepopulated


9. Collection Agent Costs, Principal

Prepopulated

Prepopulated


10. Collection Agent Costs, Interest

Prepopulated

Prepopulated


11. Litigation Costs, Principal

Prepopulated

Prepopulated


12. Litigation Costs, Interest

Prepopulated

Prepopulated


13. Credit Bureau Fees

Prepopulated

Prepopulated


14. Other Costs

Prepopulated

Prepopulated


D. Total

Total

Total


E. Cash Balance – End of Report Period



Current Year ($)

1. Cash Balance – End of Report Period

Total

2. Cash Balance – End of Report Period Adjustment


This field is grayed out for grantee. This field is only available to POs to make adjustments. This total should be carried over to the next years AOR as the Beginning Balance.



  1. Page 3

Program Accounts Section


F.1. Loan Cancellations to Borrowers – Professional Practice


Description

Cumulative (Previous Year)

Cumulative (Includes Current Year)

Current Year


Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

a. HP Practice – Shortage (10%)

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated




b. HP Practice – Rural Shortage (15%)

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated




F.1. Total




Total

Total

Total




F.2. Loan Cancellations to Borrowers – Nursing Employment

Description

Cumulative (Previous Year)

Cumulative (Includes Current Year)

Current Year


Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

a. Nursing Employment (10%)










b Nursing Employment (15%)










c. Nursing Employment (20%)










d. Nursing Employment (15%) on or after 03/23/2010










e. Nursing Employment (20%) on or after 03/23/2010










f. Nursing Employment (Other) on or after 03/23/2010










F.2. Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

F.3. Loan Cancellations to Borrowers – Death

Description

Cumulative (Previous Year)

Cumulative (Includes Current Year)

Current Year


Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

a. On HPSL Loans made on or after 10/22/85

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated




b. On Loans except those made after F.3.a

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated




F.3. Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

F.4. Loan Cancellations to Borrowers – Permanent & Total Disability Approved by HHS


Description

Cumulative (Previous Year)

Cumulative (Includes Current Year)

Current Year


Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

Number of Borrowers

Principal ($)

Interest ($)

a. On Loans made on or after 10/22/85

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated




b. On Loans except those reported after F.4.a

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated




F.4. Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

G. Bad Debts Approved For Write-Off By HHS

Description

Cumulative (Previous Year)

Cumulative (Includes Current Year)

Current Year


Number of Borrowers

Principal

Interest

Penalty Charges ($)

Number of Borrowers

Principal ($)

Interest ($)

Penalty Charges ($)

Number of Borrowers


Principal

($)

Interest

($)

Penalty

Charges

($)

Total Approved

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated

Prepopulated









  1. Page 4

Excess Cash Worksheet Section

Description

Amount ($)

A. General Ledger Cash Balance as of 6/30/2020


B. Actual Collections for 07/01/2020-06/30/2021

1. Principal


2. Interest


3. Investment Income and Penalty Charges


4. Institutional Repayments of Bad Debts (Principal, Interest & Penalty Charges)


C. Federal Funds Received/Receivable 07/01/2020-06/30/2021

1. Federal Funds Received/Receivable


D. Institutional Contribution for 07/01/2020-06/30/2021

1. Institutional Contribution


E. Projected Collections for 7/1/2021– 6/30/2022

1. Principal


2. Interest


3. Investment Income and Penalty Charges


F. Projected Funds Available as of 6/30/2022

1. Projected Funds Available (A+B+C+D+E)


G. Actual Expenditures for 07/01/2020-06/30/2021

1. Loans to Students


2. Costs (Collection, Litigation, Credit Bureau and Other)


3. Repayments to Federal Government and Institution (Principal, Interest and Other Income)


H. Projected Expenditures for 7/1/2021 – 6/30/2022

1. Loans to Students


2. Costs (Collection, Litigation and Credit Bureau)


I. Projected Expenditures as of 6/30/2022

1. Projected Expenditures (G+H)


J. Projected Cash Balance as of 6/30/2022

1. Projected Cash Balance (F-I)


K. Less Projected Expenditures for 7/1/2022 – 6/30/2023

1. Less Projected Expenditures


L. Excess Cash

1. Excess Cash (J – K)


M. General Ledger Ending Cash Balance as of 6/30/2021

1. General Ledger Ending Cash Balance










  1. Page 5

    Program Accounts Section

    H. Default Rate (Pre-populated. No entry required)

    1. Default Rate (%)

    Prepopulated

    For Active Schools

    2. Excess cash($) from report page 4 that was or will be returned to PMS

    Change the Verification Warning on this field to a regular Warning and make it editable.

    3. Excess cash($) from report page 4 that was or will be returned to the Division of Financial Operations

    Eliminate the auto-population for this field and make it editable

    For Closing Schools

    4. Amount of cash($) determined to be due the Federal Government and remitted separately to the Division of Financial Operations

    Prepopulated

    I Checklist/Questions

    1. What is the total amount ($) of interest that is past due?


    2. Does your institution provide for a biennial audit of the loan and/or scholarship funds by a qualified independent auditor?

    Yes or No question

    Audits

    MM

    YYYY

    a. Period of last audit – Start Date



    b. Period of last audit – End Date



    c. Date audit submitted to Regional Audit Agency



  2. Page 6









Program Accounts Section

1. Fully Retired


Number of Borrowers

(1)

Principal Loaned

(2)

Principal Repaid

(3)

Principal Cancelled

Principal Delinquent

(6)

Principal Uncollectible Not Past Due

(7)

Principal Outstanding but Not Due

(8)

Principal Written Off

(9)

Capitalized Interest

(10)

Reconciling Difference (Column 2 + 10 – Sum of Columns 3 through 9)

Employment as Nurse Faculty

(4)

Description

A. Repayment/Cancellation




Prepopulated








B. Cancellation/Death




Prepopulated








C. Cancellation/Disability




Prepopulated








D. Discharged in Bankruptcy




Prepopulated








E. HHS Approved Write-Off




Prepopulated








F. Uncollectible per P.L. 107-205




Prepopulated








1. Total (Sum of A through F)

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total


2. Current

Description

Number of Borrowers

(1)

Principal Loaned

(2)

Principal Repaid

(3)

Principal Cancelled

Principal Delinquent

(6)

Principal Uncollectible Not Past Due

(7)

Principal Outstanding but Not Due

(8)

Principal Written Off

(9)

Capitalized Interest

(10)

Reconciling Difference (Column 2 + 10 – Sum of Columns 3 through 9)

Employment as Nurse Faculty

(4)

Death/Disability

(5)

A. Student Status












B. Grace Period













C. Deferment Status




Prepopulated








D. Postponement/Cancellation




Prepopulated








E. Repayment – Not Past Due




Prepopulated








F. Past Due 1-119 Days




Prepopulated








2. Total (Sum of A through f)

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total


3. In Bankruptcy

Description

Number of Borrowers

(1)

Principal Loaned

(2)

Principal Repaid

(3)

Principal Cancelled

Principal Delinquent

(6)

Principal Uncollectible Not Past Due

(7)

Principal Outstanding but Not Due

(8)

Principal Written Off

(9)

Capitalized Interest

(10)

Reconciling Difference (Column 2 + 10 – Sum of Columns 3 through 9)

Employment as Nurse Faculty

(4)

Death/Disability

(5)

A. Pending Discharge/Wage Earners Agreement




Prepopulated








4. In Default

Description

Number of Borrowers

(1)

Principal Loaned

(2)

Principal Repaid

(3)

Principal Cancelled

Principal Delinquent

(6)

Principal Uncollectible Not Past Due

(7)

Principal Outstanding but Not Due

(8)

Principal Written Off

(9)

Capitalized Interest

(10)

Reconciling Difference (Column 2 + 10 – Sum of Columns 3 through 9)

Employment as Nurse Faculty

(4)

Death/Disability

(5)

A. 120 Days and Over




Prepopulated








5. Forbearance

Description

Number of Borrowers

(1)

Principal Loaned

(2)

Principal Repaid

(3)

Principal Cancelled

Principal Delinquent

(6)

Principal Uncollectible Not Past Due

(7)

Principal Outstanding but Not Due

(8)

Principal Written Off

(9)

Capitalized Interest

(10)

Reconciling Difference (Column 2 + 10 – Sum of Columns 3 through 9)

Employment as Nurse Faculty

(4)

Death/Disability

(5)

A. Forbearance




Prepopulated








Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total






  1. AOR Sub-pages

8. Age and Gender

Students by Age and Gender

Age

Males

Females

Total

Under 20




20-29




30-39




40-49




50-59




60 or Older




Unreported/Unavailable




Total






17


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSheekha Khetan
File Modified0000-00-00
File Created2021-02-15

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