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To apply for a NELRP contract, you must submit a complete application package consisting of:
- the On-Line NELRP Application;
- electronic submission of your BCRSIS Banking Information Form;
- all required Supplemental Forms (PDF - 247 KB), including the “BCRSIS Receipt of Submission”; and
- all required Supporting Documentation:
- Electronic NELRP Application
- Electronic submission of your banking information through BCRSIS
- Supplemental Forms (all of the following forms are required)
- Completed “BCRSIS Receipt of Submission”
If you are unable to print a copy
of the “BCRSIS Receipt of Submission”,
please complete the following 2 steps:
- Phone 1-800-221-9393 (TTY 1-877-897-9910), Monday-Friday, except Federal holidays, 9 am. to 5:30 pm ET.
- Complete the Banking Update Form (PDF - 112 KB) by 5 p.m. ET on March 16, 2009. The completed form must be received or postmarked by March 16, 2009. Please mail the completed form to:
Division of Applications and Awards
5600 Fishers Lane
Room 8-37
Rockville, MD 20857
- Completed Loan Information and Verification Form(s)
- Completed Employment Verification Form
- Completed Authorization for Release of Employment Information
- Completed Authorization to Release Information
- Completed NELRP Contract
- Completed Certification Regarding Debarment, Suspension, Disqualification and Related Matters
- Completed and signed Checklist
- Supporting
Documentation
- If you were born outside of the U.S., documentation of your status as a U.S. citizen, U.S. National, or Lawful Permanent Resident
- Letter/Certification from CSF (required for all applicants)
- Statement from Professional Group (if applicable)
- Promissory Note(s) (if applicable)
Instructions for completing these four components are provided in the following four sections. If any of the materials/documents described below are not included with the application, if required documents are not signed or are otherwise incomplete, or if the contract, forms and documents are not clearly printed on separate sheets of white 8½ inch x 11 inch paper, the application will be deemed incomplete and will not be considered for a NELRP award.
SEND ORIGINAL FORMS OR DOCUMENTS AS REQUIRED IN THE INSTRUCTIONS BELOW. HOWEVER, DO NOT SEND ORIGINAL PROMISSORY NOTES, LOAN CONSOLIDATION FORMS, OR PROOF OF CITIZENSHIP DOCUMENTS THAT CANNOT BE REPLACED. DOCUMENTS MUST BE RETAINED IN AN OFFICIAL FILE AND WILL NOT BE RETURNED. All mailed required supplemental forms and supporting documentation MUST be received or postmarked by March 16, 2009.
1)
Instructions for Completing the NELRP
Electronic Application
Please read this entire Applicant
Information Bulletin to determine
your eligibility for participation.
Instructions for completing the web-based
application are provided as necessary,
when you are entering your application
information electronically.
All required Supplemental Forms and required Supporting Documentation must be submitted in hard copy by March 16, 2009. Please mail the forms and documentation to:
Division of Applications and Awards
Nursing Education Loan Repayment Branch
c/o Focal Point Consulting Group
1025 Vermont Avenue, NW, Suite 1000
Washington, DC 20005
2)
Instructions for Submitting BCRSIS Banking
Information
Banking information must be submitted electronically through the BCRSIS by 5 p.m. ET on March 16, 2009. In addition, a copy of the “BCRSIS Receipt of Submission” must be printed, and submitted with the Supplemental Forms and Supporting Documentation.
Only HRSA Staff can enter any relevant
changes to the electronic banking information
once it has been submitted and a “BCRSIS
Receipt of Submission” has been
printed. However, if changes are
required, you must complete the Banking
Update Form (PDF - 112 KB) and mail the completed Banking Update
Form to the Division of Applications and
Awards, Nursing Education Loan Repayment
Branch, 5600 Fishers Lane, Room 8-37,
Rockville, MD 20857.
3)
Instructions for Completing Required Supplemental
Forms
Loan Information and Verification
Form(s)
Applicants must complete a Loan Information and Verification Form (Loan Form) for each lender (or holder) for the nursing education loan(s) they wish to be considered for repayment. This form also authorizes the lender(s) or holder(s) to release information about the applicant’s loan(s) to the NELRP. (If additional forms are needed, please download/print them or photocopy the form).
Be sure to include the most current lender (or holder) of the loan and the lender's (or holder's) complete address and telephone number. Provide the lender’s (or holder’s) automated access telephone number that will permit the NELRP to obtain loan information for verification purposes. The most current balance of each loan — principal and interest — must be determined as accurately as possible and reported on the Loan Form.
Applicants must include ALL loan balances for undergraduate and/or graduate nursing education with the initial application. Only those loan balances submitted with the initial application will be considered for an award.
Applicants who have consolidated/refinanced their loans must provide either (1) a copy of their promissory note(s) for the original loan(s) or (2) a copy of the consolidated promissory note from the current lender(s) that shows, for each loan being consolidated, the amount, date of original disbursement, and type of loan. NOTE: Master Promissory Notes are not acceptable because they do not provide the required information (i.e., original loan dates and amounts). Examples of qualifying loans are provided in Section H
of this Bulletin. Please note that for consolidated/refinanced loans, copies of promissory notes submitted must clearly identify the original loans that were for eligible costs of nursing education. If an eligible educational loan is consolidated/refinanced with any debt other than another eligible educational loan of the applicant, no portion of the consolidated/refinanced loan will be eligible for loan repayment.
If undergraduate or graduate nursing educational loans have been consolidated or refinanced, the documentation noted above is required to establish that the loans coincide with the nursing education periods stated on the Application.
Applicants who have Perkins loans that are not eligible for cancellation must also provide documentation (a) from the school that the loans are not subject to cancellation under 34 C.F.R. Part 674, or (b) from the current lender or holder indicating that the Perkins loans were consolidated and paid off.
Employment Verification Form
The applicant’s employer must fill out this form completely and return it to the applicant for submission with the other application materials. Please note that while the employer is responsible for completing the form, the applicant is responsible for assuring that all information is entered accurately, and the applicant is responsible for the timely submission of the completed form.
Authorization for Release of Employment
Information Form
This form must be completed by the applicant to authorize the release of information regarding the applicant’s employment status to the NELRP. If the applicant is awarded a NELRP contract, his/her employment status will be verified semiannually.
Authorization to Release Information
This form authorizes HHS, and/or its contractors, to release information that identifies the applicant for purposes of obtaining the applicant’s credit report and educational loan information and checking whether the applicant appears on the Excluded Parties List System. It also authorizes any program to which the applicant owes a health profession service obligation to release such information to HHS and/or its contractors.
NELRP Contract
Before signing the NELRP contract, an applicant should carefully review all 13 terms and conditions to be certain that he/she fully understands the obligations of a NELRP participant and the Secretary as described in the contract. In particular, an applicant should carefully review paragraph 7 relating to breaching the contract and paragraph 9 relating to a waiver or suspension of the obligation. The applicant’s signature alone on the contract does not constitute a contractual agreement. This contract becomes legally binding only when signed by the Secretary or his/her designee, which will occur between July and September 2009, if the applicant receives a NELRP award.
No service credit will be given for employment at a CSF before the effective date of a NELRP contract award. The effective date of a contract award is the date the contract is countersigned by the Secretary or his/her designee.
The complete contract (header, signature blocks, and all 13 terms and conditions) must be included on one 8½ x 11 inch piece of paper. A signed NELRP contract that does not meet these requirements is not acceptable and will result in the applicant not being considered for a NELRP award.
Completed Certification Regarding
Debarment, Suspension, Disqualification
and Related Matters
This form describes the regulatory requirements for a “covered transaction” such as the receipt of funding under the NELRP. Applicants should read the entire form and sign the Certification at the bottom of the form that is applicable to their situation.
Completed Checklist
The Checklist assists applicants and the NELRP staff in verifying the completeness of the application. Return the checklist along with all of the other required application materials. Carefully read the certification statement at the bottom of the checklist. The Checklist must be signed for the application to be considered complete.
4) Instructions for Providing
Required Supporting Documentation
- Documentation of Status as a U.S.
Citizen, U.S. National, or Lawful Permanent
Resident (if applicable). Applicants born outside of the United States must provide proof of U.S. citizenship or status as a U.S. National or Lawful Permanent Resident (e.g., a copy of a certificate of citizenship or naturalization, U.S. Passport ID page, or Green Card).
- Letter/Certification from CSF Verifying
its Status (Original Letters Only)
- All applicants must provide a letter/certification
from the facility verifying its status
as one of the types of CSFs specified
in Section C of this
Bulletin. Letters must
also indicate if the facility is private
nonprofit, private for profit, or public/government
owed.
- Letters from sites must be dated on or after February 2, 2009, when the NELRP application cycle began. Letters that are not dated or dated before the application cycle begins will not be accepted.
- DSH Status Verification. An applicant who is employed by, or works for a professional group that practices at, a DSH (see Types of Critical Shortage Facilities) must obtain a letter (on original letterhead, signed by an appropriate hospital official) verifying the hospital’s current status as a DSH (i.e., the hospital receives (a) an augmented payment from the State under Medicaid or (b) a payment adjustment for Medicare). A report listing of DSH facilities is not acceptable.
- Health Center/Rural Clinic/IHS Health Center. An applicant who is employed by, or works for a professional group that practices at, a Federally Designated Health Center, Federally Designated Health Center Look-Alike, Indian Health Service Health Center, or Rural Health Clinic, must obtain a letter (on original letterhead, signed by an appropriate facility official) or a copy of an official certificate from the facility verifying, as applicable, that it is (a) the recipient of a Federal grant as described in Section
C of this Bulletin, or (b) receives funds from another organization under a grant as described in Section
C of this Bulletin, or (c) is certified as specified in Section
C of this Bulletin.
- Nursing Home. An applicant who is employed by,
or works for a professional group that
practices at, a Nursing Home must obtain
a letter (on original letterhead, signed
by an appropriate facility official)
verifying that the facility is an institution
(or a distinct part of an institution),
certified under section 1919(a) of the
Social Security Act, and is primarily
engaged in providing, on a regular basis,
health-related care and services as
specified in Section
C of this Bulletin.
- Public Health Department. An applicant who is employed by, or works for a professional group that practices at, a State or Local Public Health Department, including a Public Health Clinic within the Department, must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying that the facility is a State, county, parish, or district entity responsible for providing population focused heath services as specified in Section
C of this Bulletin.
- Federal Hospital. An applicant who is employed by, or works for a professional group that practices at, a Federal Hospital must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying the facility is primarily engaged in providing, by or under the supervision of physicians, to inpatients: (a) diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or (b) rehabilitation of injured, disabled, or sick persons. Hospital-based outpatient services are included under this definition as specified in Section
C of this Bulletin.
- Non-Federal, Non-DSH Hospital. An applicant who is employed by, or works for a professional group that practices at, a Non-Federal Non-Disproportionate Share Hospital must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying that the facility is a public or private nonprofit institution in a State and is primarily engaged in providing, by or under the supervision of physicians, to inpatients: (a) diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or (b) rehabilitation of injured, disabled, or sick persons. Hospital-based outpatient services are included under this definition as specified in Section
C of this Bulletin.
- Ambulatory Surgical Center. An applicant who is employed by, or works for a professional group that practices at, a Ambulatory Surgical Center must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying that the facility is in a State and provides surgical services to individuals on an outpatient basis and is not owned or operated by a hospital as specified in Section C of this Bulletin.
- Home Health Agency. An applicant who is employed by, or works for a professional group that practices at, a Home Health Agency must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying that the facility is a public agency or private organization, certified under section 1861(o) of the Social Security Act, that is primarily engaged in providing skilled nursing care and other therapeutic services as specified in Section C of this Bulletin.
- Hospice Program. An applicant who is employed by, or works for a professional group that practices at, a Hospice Program must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying that the facility is a public agency or private organization, certified under section 1861(dd)(2) of the Social Security Act, that provides 24-hour care and treatment services (as needed) to terminally ill individuals and their families. This care is provided in individuals’ homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the agency or organization as specified in Section
C of this Bulletin.
- Native Hawaiian Health Center. An applicant who is employed by, or works for a professional group that practices at, a Native Hawaiian Health Center must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying that the facility is an entity (a) which is organized under the laws of the State of Hawaii; (b) which provides or arranges for health care services through practitioners licensed by the State of Hawaii, where licensure requirements are applicable; (c) which is a public or nonprofit private entity; and (d) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health services as specified in Section
C of this Bulletin.
- Skilled Nursing Facility. An applicant who is employed by, or works for a professional group that practices at, a Skilled Nursing Facility must obtain a letter (on original letterhead, signed by an appropriate facility official) verifying that the facility is an institution (or a distinct part of an institution), certified under section 1819(a) of the Social Security Act, that is primarily engaged in providing skilled nursing care and related services to residents requiring medical, rehabilitation or nursing care and is not primarily for the care and treatment of mental diseases as specified in Section
C of this Bulletin.
- Advanced Practice Nurses Employed by a Professional Group that practices at a CSF must provide a written statement from the professional group (on original letterhead, signed by an appropriate official) stating that the applicant will be working exclusively at one designated CSF for at least 32 hours per week (for a minimum of 45 weeks per service year) for the 2-year duration of the applicant’s NELRP contract, if the applicant receives an award. Letters from professional groups must be dated on or after February 2, 2009, when the application cycle began. Letters that are dated before the application cycle began will not be accepted.
Please notice the "WARNING" and “CERTIFICATION” at the beginning and at the end of the electronic application, respectively, concerning the provisions of Federal law (the United States Code) for knowingly making false statements or misrepresentations.
The electronic application and BCRSIS Banking Information must be submitted by 5 pm ET on March 16, 2009. All required supplemental forms and all required applicable supporting documentation, including the “BCRSIS Receipt of Submission” must be received or postmarked by March 16, 2009.
Failure to provide ALL information on ALL required forms and required supporting documentation described on this page of this
Bulletin by the above deadlines will result in the application being deemed ineligible. The NELRP staff will perform no further review of missing, inaccurate, illegible, or incomplete application materials.
- Applicants to the NELRP (i.e., individuals who have not been formally notified that they have been awarded an NELRP contract) who have questions regarding the application process or the status of an application or award should contact the:
Nursing Education Loan Repayment Branch
Division of Applications and Awards
Bureau of Clinician Recruitment and Service
Health Resources and Services Administration
5600 Fishers Lane, Room 8-37
Rockville, Maryland 20857
Telephone: 1-800-221-9393 (TTY for hearing impaired: 1-877-897-9910)
E-mail:
CallCenter@hrsa.gov
Please mail required supplemental forms
and supporting documentation to:
Division of Applications and Awards
Nursing Education Loan Repayment Branch
c/o Focal Point Consulting Group
1025 Vermont Avenue NW, Suite 1000
Washington, DC 20005
- Participants in the NELRP (i.e., individuals who have been formally notified that they have received a NELRP contract) requiring additional information or assistance during their service obligation should contact:
Clinician Service Support Branch
Division of Scholar and Clinician Support
Bureau of Clinician Recruitment and Service
Health Resources and Services Administration
5600 Fishers Lane, Room 8-15
Rockville, Maryland 20857
Telephone 1-800-221-9393 (TTY: 1-877-897-9910)
E-mail: CallCenter@hrsa.gov
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