Nurse Faculty Loan Program Forms

Forms and Documents

Document Name	Status
Form 3 NFLP Due Diligence Form Form	Modified
Form 3 NFLP Due Diligence Form Form	Modified
Form 2 Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form Form and Instruction	Modified
Form 2 Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form Form and Instruction	Modified
Form 1 Nurse Faculty Loan Program Forms- Program Specific Data Form Form and Instruction	Modified
Form 1 Nurse Faculty Loan Program Forms- Program Specific Data Form Form and Instruction	Modified
NFLP Supporting Statement - 8.9.23 Change Memo Edited.docx Supporting Statement A	2023-08-09
NFLP Supporting Statement - 8.9.23 Change Memo Edited.docx Supporting Statement A	2023-08-09
Non Substantive Change Request_8-9-23 Final.docx Justification for No Material/Nonsubstantive Change	2023-08-09
Non Substantive Change Request_8-9-23 Final.docx Justification for No Material/Nonsubstantive Change	2023-08-09

IC Document Collections

IC ID	Document Title	Status
260347	NFLP Due Diligence Form Form	Modified
260347	NFLP Due Diligence Form Form	Modified
241796	Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form Form and Instruction	Modified
241796	Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form Form and Instruction	Modified
182194	Nurse Faculty Loan Program Forms- Program Specific Data Form Form and Instruction	Modified
182194	Nurse Faculty Loan Program Forms- Program Specific Data Form Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0314	ICR Reference No: 202308-0915-003
Status: Active	Previous ICR Reference No: 202305-0915-005
Agency/Subagency: HHS/HSA	Agency Tracking No: 21370
Title: Nurse Faculty Loan Program Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/10/2023
	Date Received in OIRA: 08/09/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	08/31/2026	08/31/2026
Responses	317	0	317
Time Burden (Hours)	1,982	0	1,982
Cost Burden (Dollars)	0	0	0

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Abstract: This clearance request is for approval of both the Nurse Faculty Loan Program (NFLP) Program Specific Data Form and the Annual Performance Report (APR) Financial Data Form under the OMB Approval No. 0915-0314. The Program Specific Data Form is currently approved under OMB Approval No.: 0915-0378 with an expiration date of 7/31/2020 and the APR Financial Data Form is currently approved under OMB Approval No: 0915-0314 with an expiration date of 7/31/2020. The APR Form was previously titled as the Nurse Faculty Loan Program, Annual Operating Report.

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Authorizing Statute(s): US Code: 42 USC 297n-1, Section 846A Name of Law: Title VIII, PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 14378	03/08/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 33148	05/23/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
NFLP Due Diligence Form	3	NFLP Due Diligence Form
Nurse Faculty Loan Program Forms- Annual Performance Report Financial Data Form	2	NFLP Annual Performance Report Financial Data Form
Nurse Faculty Loan Program Forms- Program Specific Data Form	1	NFLP Program Specific Data Form

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ICR Summary of Burden

	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	317	317	0	0	0	0
Annual Time Burden (Hours)	1,982	1,982	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $15,057

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/09/2023

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