PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Application Checklist and Self-Certification Form
Modified
8000
4000
0
Form
NELRP_006
Application Checklist and Self-Verification Form
Authorization for Release of Employment Information Form
Modified
8000
800
0
Form
NELRP_006
Authorization for Release of Employment Information Form
Authorization to Release Information Form
New
8000
800
0
Form
NELRP_008
Authorization to Release Information Form
Certification Of Accreditation Status for School of Nursing Education Programs Form
New
500
50
0
Form
NELRP_010
Certification Of Accreditation Status for School of Nursing Education Programs Form
Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form
New
8000
800
0
Form
NELRP_009
Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form
Employment Verification and Critical Shortage Facility Form
Modified
7500
3750
0
Form
NELRP_003
Employment Verification and Critical Shortage Facility Form
Employment Verification for Nurse Faculty Appointment Form
New
500
125
0
Form
NELRP_004
Employment Verification for Nurse Faculty Appointment Form
Loan Information and Verification Form
Modified
24000
24000
0
Form
NELRP_2
Loan Information and Verification Form
Participant Semi-Annual Employment Verification Form
Modified
4600
2300
0
Form
7
Emp Verification Form
Pre-Award Script
Removed
0
0
0
Form
6
Pre-Award Script
The Nursing Education Loan Repayment Program Application
Modified
8000
12000
0
Form and Instruction
NELRP_001
Application Guidance and Forms
Instruction
The Verification of Acceptance or Decline of Award form
New
1200
300
0
Form
NELRP_11
The Verification of Acceptance or Decline of Award form
Total burden requested under this ICR:
78300
48925
0
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