OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202102-2900-002 · OMB 2900-0879 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 10-255e SELRP - Participant Agreement Form Modified Missing upstream
Form 10-255d SELRP - Mobility Agreement Form and Instruction Modified Repair queued
Form 10-255c SELRP - Education Loan Verification Form and Instruction Modified Repair queued
Form 10-255b SELRP - Program Status Verification Form Modified Repair queued
Form 10-255a SELRP - Application Form and Instruction Modified Repair queued
Supp Statement A_Spec Educ Loan Repay Prog (SELRP)_AQ63_revised Feb 2021.docx Supporting Statement A Uploaded 2021-02-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
241717 SELRP - Participant Agreement Form Modified
241716 SELRP - Mobility Agreement Form and Instruction Modified
241715 SELRP - Education Loan Verification Form and Instruction Modified
241714 SELRP - Program Status Verification Form Modified
241713 SELRP - Application Form and Instruction Modified
ICR Details
2900-0879 202102-2900-002
Received in OIRA 201912-2900-003
VA 2900-NEW
Specialty Education Loan Repayment Program (SELRP) Forms [AQ63]
New collection (Request for a new OMB Control Number)   No
Regular 02/16/2021
  Requested Previously Approved
36 Months From Approved
1,000 0
283 0
0 0
Section 303 of Public Law 115-182, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, or the VA MISSION Act of 2018, amended title 38 of the United States Code (U.S.C.) by establishing new sections 7691 through 7697 and created a new student loan repayment program known as the Specialty Education Loan Repayment Program (SELRP). The SELRP will serve as an incentive for physicians starting or currently in residency programs in medical specialties for which VA has determined that recruitment and retention of qualified personnel is difficult to work for VA at VA facilities that need more physicians with that medical specialty. Section 303 of the VA MISSION Act of 2018 did not establish an application procedure for the SELRP. To maintain consistency in the application process of similar VA scholarship programs and to ease the implementation such programs by VA personnel, VA will mirror proposed § 17.528 to current § 17.643, Application for the Program for Repayment of Educational Loans for Certain VA Psychiatrists (PREL.) Consistent with § 17.643(a), proposed paragraph § 17.528(a) will state that a complete application for the SELRP consists of a completed application, letters of reference, and personal statement.
PL: Pub.L. 115 - 182 303 Name of Law: MISSION Act of 2018
  
None
2900-AQ63 Final or interim final rulemaking 85 FR 45532 07/29/2020
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 1,000 0 0 1,000 0 0
Annual Time Burden (Hours) 283 0 0 283 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
There is a slight reduction in burden hours due to adjustment of anticipated time to complete one form in the collection.
$12,187
No
    Yes
    Yes
No
No
No
No
Frances O'Donnell 703 405-2449 [email protected]
  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.
02/16/2021