IHS Loan Repayment Program Application Handbook LRP573 LRP
User Manual: LRP573
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Page Count: 48
- Indian Health Service Loan Repayment Program Application Handbook
- Introduction
- Welcome Letter
- Privacy Act Notice
- Contents
- The IHS Loan Repayment Program
- Qualifying Loans and LRP Payments
- IHS Loan Repayment Service Obligation
- How to Apply
- About LRP Application Forms
- Application and Award Deadlines
- How to Reapply If You Are Not Selected
- How to Complete the Application
- Using the Checklist
- Section 1: How to Complete the General Applicant Information Section
- Section 2: How to Complete the Educational and Professional Background Section
- Section 3: How to Complete the Financial Information Section
- Section 4: A Review of the Comparison of Benefits Between Commissioned Corps and Civil Service (Including Affidavit)
- Section 5: About the Sample Contract
- LRP Application Forms
- Recruiter Information
How to Apply
Apply Here for
Financial Freedom
This booklet describes the Indian Health Service (IHS) Loan Repayment
Program (LRP) and explains the application process. Application forms are
included. If any changes should occur in the LRP program before contracts
become effective, prospective recipients will be provided with revisions
to this booklet prior to the conclusion of any loan repayment agreements.
Please write or call the LRP office if you have any questions about the
program or the application process.
The information in this handbook is subject to change without notice. Please
refer to for the most up-to-date information.
Dear Colleague,
Thank you for your interest in the Loan Repayment Program (LRP).
A career with the Indian Health Service (IHS) is an opportunity for professional and personal
fulfillment — a chance to experience the rewards of working with an appreciative, underserved
population while living in some of the most beautiful areas of the country.
The costs of a health professional education are high, but the LRP can give you the financial
freedom to pursue the future you’ve envisioned for yourself: a career with purpose and a sense
of mission, treating patients who truly need you, and doing it all with adventure in your life. It’s
no wonder that health professionals consider the LRP to be one of the most significant benefits
IHS offers. On behalf of the Indian Health Service, thank you for your interest in providing health
care to American Indians and Alaska Natives.
Robert E. Pittman, R.Ph., M.P.H.
Rear Admiral, USPHS
Assistant Surgeon General
Director, Division of Health Professions Support
Privacy Act Notice
General
This information is provided to you in accordance with the Privacy Act of 1974 (Public Law [P.L.] 93-579), as you are supplying us with
information for inclusion in a system of records.
Authority
Section 108 of the Indian Health Care Improvement Act (P.L. 94-437), as amended by the Indian Health Care Amendments of 1992 (P.L. 102-573).
Program Administration
The LRP is administered at the IHS Office of Public Health Support, Division of Health Professions Support. The IHS is one of 11 agencies of the
US Department of Health and Human Services (HHS).
Purpose and Uses
The purpose of the LRP is to obtain health professionals to meet the staffing needs of the IHS in Indian health programs.
The information you supply will be used to evaluate your eligibility for participation in the LRP. Your application and related data are included in
a file to be used within HHS for recordkeeping and recipient management while you are in the program. The information may also be disclosed
in accordance with the Privacy Act and IHS Privacy Act Systems of Records Notice 09-17-0002; disclosures to the public as required by the
Freedom of Information Act, to the Congress, the National Archives, the Bureau of Accounting Office; and pursuant to court order. Your name
(if awarded), the professional school you attend or have attended, and the date of graduation may be made available to health professions
associations and to groups who have responsibility for coordinating educational loan repayment funds paid to individuals from federal and other
sources, and to individuals and organizations deemed qualified by the Secretary of the US Department of Health and Human Services to carry
out such research.
Effects of Nondisclosure
Under the Debt Collection Act, you are required to disclose your Social Security number (SSN) if you are awarded loan repayment. If you do
not disclose your SSN, your application will be considered incomplete.
Discrimination Prohibited
Title VI of the Civil Rights Act of 1964, as amended, provides that no person in the United States (US) shall, because of race, color, or national
origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving
federal financial assistance.
Section 504 of the Rehabilitation Act of 1973, as amended, provides that no otherwise qualified handicapped individual in the US shall, solely
by reason of his/her handicap, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program
or activity receiving federal financial assistance.
Contents
1 The IHS Loan Repayment Program
3 Are You Eligible?
3 What Is an Indian Health Program?
3 How Are Recipients Selected?
3 Award Distribution
5 Qualifying Loans and LRP Payments
7 Qualifying Loans
7 Verification of Total Debt From Qualified Loans
7 Payments
7 LRP Payment Examples
8 Delinquency on the Repayment of Any Federal Debt
8 Loans Not Eligible for Repayment
9 IHS Loan Repayment Service Obligation
11 Service
11 Being Matched to a Site
11 Employment Options
13 How to Apply
15 About LRP Application Forms
15 Application and Award Deadlines
15 How to Reapply If You Are Not Selected
15 How to Complete the Application
15 Using the Checklist
16 Section 1: How to Complete the General Applicant
Information Section
17 Section 2: How to Complete the Educational
and Professional Background Section
18 Section 3: How to Complete the Financial
Information Section
18 Section 4: A Review of the Comparison of Benefits
Between Commissioned Corps and Civil Service
(Including Affidavit)
18 Section 5: About the Sample Contract
19 LRP Application Forms
21 Application Checklist
22 Section 1: General Applicant Information
24 Section 2: Educational and Professional Background
26 Section 3: Financial Information
27 Section 4: Comparison of Benefits Between
Commissioned Corps and Civil Service
(Including Affidavit)
30 Section 5: Sample LRP Contract
35 Recruiter Information
37 Recruiter Offices
38 IHS Discipline Chiefs
The IHS Loan
Repayment Program
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The IHS Loan Repayment Program
Are You Eligible?
All health professions are eligible to apply to the LRP. However,
the professions that are actually funded change each year
depending on Indian health program staffing needs. Please refer to
for the current year’s priority list.
Applicants for the LRP must be health or allied health professionals who:
• Are US citizens
• A re committed to practice at an IHS or other Indian health
program priority site
• Can begin service on or before September 30 for two continuous
years of full-time clinical practice
• Have a degree in a health profession*
• Have a valid state license to practice in a health profession
* Health professions eligible to apply: allopathic medicine and osteopathic medicine
(various specialties as needed), podiatric medicine, physician assistant, nursing, public
health nursing, dentistry, optometry, pharmacy, psychology, social work, environmental
health, engineering, an allied health profession, or other health professions as
determined by need.
What Is an Indian Health Program?
For LRP purposes, the term “Indian health program” is defined in
the Indian Health Care Improvement Act (IHCIA; P.L. 94-437), as
any health program or facility funded in whole or in part by IHS for
the benefit of American Indians and Alaska Natives. These health
programs or facilities must be administered directly by IHS, by any
Indian Tribe or any Tribal or Indian organization contracted under
The Indian Self-Determination Act, the Buy Indian Act, or by an
Urban Indian organization pursuant to Title V of the IHCIA.
How Are Recipients Selected?
IHS has created a ranking system to distribute LRP awards with the
utmost fairness. As the goal of the program is to fill staff vacancies
in Indian health programs, the ranking system gives highest
consideration to program staffing needs and shortages of specific
health profession disciplines. Once the need is assessed, each site
is ranked accordingly. Please refer to
for the latest priority list.
Consistent with this priority, considerations in ranking
applicants include:
• American Indian/Alaska Native — IHS gives priority to applicati ons
made by American Indians and Alaska Natives and to individuals
recruited through the efforts of Indian Tribes and Tribal or
Indian organizations.
• Current Service — Current LRP recipients requesting contract
extensions are given priority over new awards.
When all other factors are equal between applicants, additional
equal-weight factors are applied. Applicants who meet more of
the following factors than other applicants will be selected:
• Current employment in an IHS, Tribal or Urban program.
• Date of availability for service (first come, first served).
• Date the application was received by the LRP.
• Previous IHS Scholarship Program recipient.
Applicants will be accepted into the LRP
according to the above priorities as long as
funds remain available during the fiscal year.
Award Distribution
Each year, funds appropriated for the LRP are distributed among
the health professions depending on health program staffing needs.
Qualifying Loans
and LRP Payments
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Qualifying Loans and LRP Payments
Please refer to the Federal Register notice for the current fiscal year
for any updates or changes to the benefits of the program.
Qualifying Loans
The LRP repays qualifying health professions education loans
as follows:
• Qualifying loans are limited to government (federal, state, loc al)
and commercial loans used to pay for health professions schools.
• The LRP pays directly to the recipient the principal, interest, and
related expenses (including tuition, fees, books, lab expenses
and reasonable living expenses) incurred for qualifying health
professions educational loans.
• Up to $20,000 per year in loan repayment can be awarded
to recipients (in addition to their salary) who sign a contract
agreeing to a two-year service obligation.
• Twenty percent of the federal income tax liability on the LRP
award as well as the recipient’s portion of the related FICA
obligation are included in the award, with payment made
directly to the Internal Revenue Service.
• For consolidated loans (health professions education loans
combined with commercial or other education loans), only the
health professions education portion can be eligible under the
LRP. Applicants must provide copies of final statements from the
original lending institution at the time of the loan consolidation
to determine the portion eligible for repayment.
Documentation is required for all loans. However, verification of
the purposes for which the loan was obtained is required for some
loans. A number of federal program loans don’t require additional
lender verification since they already meet statutory requirements.
These include:
• Health Education Assistance Loan (HEAL) Program
• Guaranteed Student Loan (GSL) Program
• P erkins Loan, formerly National Direct Student Loan
(NDSL) Program
• Health Professions Student Loan (HPSL) Program
• Supplemental Loans for Students (SLS)
• Parent Loans for Undergraduate Students (PLUS) Loans
All other loans require lender verification, including loans from
undergraduate and graduate health professions schools.
Verification of Total Debt From Qualified Loans
When you are selected for participation in the LRP, copies of your
financial information (Section 3 of the application) are used to verify
total debt from your qualified education loans. Loan repayments will
begin once the contract has been signed by you and by the Secretary
of HHS or the Secretary’s IHS delegate, as provided in Section D of the
LRP contract.
Payments
LRP payments are made to recipients in addition to the salary they
receive for their employment. Letters of acceptance are sent on
the last day of each month. If you are already employed by IHS
or another Indian health program, LRP payments will begin within
120 days from the date the Secretary’s delegate signs the contract.
For new LRP recipients who are not currently serving at an Indian
health system facility, your payments begin 120 days from your
entry-on-duty date or the start of your LRP contract date, whichever
is later.
LRP Payment Examples
The following charts are examples of LRP payments for three
different qualifying loan scenarios. Each example shows how annual
payments are made.
Recipient with a two-year service contract and $90,000 in
qualifying education loans.
Total
Payments
Made
by IHS
$25,836
Recipient with a two-year service contract and $30,000 in
qualifying education loans.
If the recipient’s total loan amount can be paid within the two-year
service obligation or is less than $40,000, the amount will be divided
in half and awarded over two years.
Total
Payments
Made
by IHS
$19,377
Recipient with a consolidated education loan.
In this example, a recipient has obtained a professional degree
in nursing and nutrition and comes to work at IHS as a registered
nurse. Only the loans obtained in pursuit of the nursing education
($36,000) are eligible for repayment, while those obtained for the
nutrition training are not.
Total
Payments
Made
by IHS
$23,252
Delinquency on the Repayment of Any Federal Debt
If you are delinquent on the repayment of any federal debt, you
must provide with your LRP application documentation from your
lender that you have negotiated a repayment schedule or that
your federal debt is paid in full. If this has not occurred, the LRP will
not award a loan. If you have been awarded a loan and it is later
discovered that you do have delinquent debt, your LRP payments
could be garnished to satisfy delinquent debt unless you negotiate
a repayment schedule. Examples of federal debt include:
• Delinquent federal income taxes
• Audit allowances
• Federally guaranteed (or insured) loans
• Federal-direct loans
• Other miscellaneous federal administrative debts
Loans Not Eligible for Repayment
Any debts consisting of a service obligation must be satisfied prior to
applying to the LRP. Any debts due to defaulted service obligations
incurred under federal or state programs are not eligible for
repayment under the LRP. Examples of these types of debts include,
but are not necessarily limited to, the following:
• The Physicians Shortage Area Scholarship Program
• The Public Health Service and National Health Service Corps
Scholarship Program
• T he IHS Health Professions Scholarship Program (P.L. 94-437,
Section 104)
• A rmed Forces (Air Force, Army, Marines or Navy) Health
Professions Scholarship Programs
• Any loan that requires a service obligation
Also ineligible for repayment are:
• Any credit card debt
• Loans from other than approved government and commercial
sources (e.g., loans obtained from private organizations, friends
or relatives)
• Loans or portions of loans obtained in pursuit of a different
health profession from the one in which you are hired for the
program. For example, if you obtain a professional degree in
nutrition and nursing and come to work at IHS as a registered
nurse, only the loans obtained in pursuit of the nursing education
are eligible for repayment, while those obtained for the nutrition
training are not.
IHS Loan Repayment
Service Obligation
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IHS Loan Repayment Service Obligation
Service
LRP recipients must serve their two-year contracted period in
an IHS-approved priority site. IHS annually ranks all Indian health
program sites in order of priority by position, with priority given to
sites with the greatest vacancy rates and need. Please refer to
for the most recent priority listing.
Being Matched to a Site
Your selection for participation in the LRP is contingent on your
having received an offer of full-time employment at an approved
LRP site and agreed to begin service there before the end of the
fiscal year (September 30). Your discipline-specific IHS Public Health
Professions (PHP) recruiter will work with you to explore employment
opportunities at IHS priority sites. To find your discipline-specific IHS
recruiter, go to and click Contact Us.
Employment Options
The LRP service obligation can be fulfilled through employment
for the service period under any of several personnel systems. LRP
recipients can choose from the following employment options to
fulfill their service obligation:
• US Public Health Service Commissioned Corps — Commissioned
officer with a salaried appointment.
• Federal Civil Service — General Schedule (GS) employee.
• Tribal Hire — Employee of a Tribal program conducted under
an Indian Self-Determination and Education Assistance Act
(P.L. 93-638) contract.
• Urban Indian Program Employee — In a program assisted under
Title V of the Indian Health Care Improvement Act (P.L. 94-437).
• Buy Indian Contract Employee.
Section 4 of this booklet contains full information on the Commissioned
Corps and the federal Civil Service personnel systems, as required by
law, so you can make an informed decision as to which service (if
applicable) you would prefer if accepted into the program. An affidavit
is included for you to sign, stating that you’ve been provided with and
have read this information on the two personnel systems used by IHS,
and that you understand the differences between the two.
You must maintain a satisfactory level of employee performance
at your approved site. Failure to meet these standards can result in
termination of employment and therefore cause a breach of your
LRP contract.
How to Apply
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How to Apply
About LRP Application Forms
This booklet contains a complete set of LRP application forms. If you
need additional forms or booklets, or have any questions, please
contact the program at:
Indian Health Service
Loan Repayment Program
801 Thompson Ave., Suite 120
Rockville, MD 20852
Phone: (301) 443-3396
Fax: (301) 443-4815
8:00 a.m.– 5:00 p.m. (EST), Monday through Friday (except federal holidays)
Application and Award Deadlines
Applications are accepted all year, but are
processed for consideration from January through
September 30 each award year, or until all funds
are exhausted. The application deadline is the
Friday of the second full week of each month.
Successful applicants must begin their service
period no later than September 30 of the fiscal
year in which they were accepted into the LRP.
How to Reapply If You Are Not Selected
You will be notified by mail by October 31 if you are not selected for
an LRP award. If you wish to reapply in the next LRP award cycle,
you are required to notify LRP in writing. Your application will be
kept on file and considered for all funding cycles.
How to Complete the Application
This section takes you step by step through the LRP application.
When you are finished, please review your application carefully
before submitting. The checklist provided will assist you in
preparing your application, and you should submit it along with
your application. LRP applications must be complete and include
all required support documentation. Incomplete applications are
not eligible for consideration.
The application is composed of five sections:
Section 1: General Applicant Information
Section 2: Educational and Professional Background
Section 3: Financial Information
Section 4: Comparison of Benefits Between Commissioned
Corps and Civil Service (Including Affidavit)
Section 5: Sample LRP Contract (an official contract will be
sent to you if you’re chosen for an award)
Please pay special attention to the Section 3 forms, which request
details of all qualified loans you want considered for repayment. If
you have more than one loan, complete a separate form for each
individual loan. Make copies of a blank form if you need more forms
than are provided. It is important that you submit all of these forms
along with your application, as no additional forms will be accepted
once an award is approved.
Complete all sections of the application and review the information
carefully before submitting. Mail the original forms, including the
completed checklist, and any required documentation to:
Indian Health Service
Division of Health Professions Support
Loan Repayment Program
801 Thompson Ave., Suite 120
Rockville, MD 20852
Please retain a copy of the entire application for your personal records.
You will be notified by letter if you are approved for participation in
the LRP, and an official contract will be sent to you.
Using the Checklist
The checklist is included to assist you in preparing your application
and to ensure that it is complete. Check off each item as you
complete it and gather the documentation required. Return the
completed checklist along with your completed application.
Section 1: How to Complete the General Applicant
Information Section
The first section of the application covers general applicant
information, including personal data, education information and
details of existing service obligations.
Line 1 — Name
Provide your full legal name — last name first, then first name and,
if applicable, middle name.
Line 2 — Social Security Number (SSN)
Enter your SSN on line 2. If you don’t provide it on your application
and you are later selected for an LRP award, you will be required at
that time to provide your SSN for purposes of payroll and payment to
you of LRP benefits. This is a condition of your award.
Lines 3 and 4 — Home Address, Home Telephone and Email
Provide your full address, including apartment number if applicable,
on line 3. Enter your home phone number, including area code, and
your primary email address on line 4.
Lines 5 and 6 — Work/School Address and Telephone/Email
Provide your address at work or school, if applicable, on line 5. Be
sure to include any apartment, room or mail stop numbers. On line 6,
enter your work or school phone number, and your work/school
email address if you have one and it’s different from your primary
email address. If you do not have a work or school address, skip line 5
and 6 and go to line 7.
Line 7 — Date of Birth
Provide your date of birth here (mm/dd/yyyy).
Line 8 — Employment at IHS
If you are currently employed with IHS, check the YES box and go to
line 8a. If you are not currently employed with IHS, check the NO box
and go to line 8b.
Line 8a — If you are employed with IHS and checked YES, this li ne
requests details of your IHS employment. Check the appropriate
box if you are in the USPHS Commissioned Corps or a federal Civil
Service employee. Provide your entry date (the date you started
work with IHS) and the site or location where you are employed.
If you’re currently employed with IHS, provide employment
verification documentation, as applicable:
• IHS employment documentation (a letter from your employer
stating dates of employment, full- or part-time status, job title,
site name and entry-on-duty date)
• T ribal employment documentation (a letter on Tribal
letterhead stating dates of employment, full- or part-time
status, job title, site name and hire date)
• Commissioned Corps orders
• Standard Form 50B (SF-50B), also known as SF-50, is the
Notification of Personnel Action. If you have ever been employed
with the federal government, this form documents your service.
Line 8b — If you are not employed with IHS and have checked NO,
this line determines if you are employed in a program conducted
or assisted under certain federal laws and acts. Contact your
human resources department for assistance in determining the
status of your program.
• Check the first choice if you are employed in a program
conducted under a contract entered into under the Indian
Self-Determination and Education Assistance Act (P.L. 93-638
as amended).
• Check the second choice if you are employed in a program
assisted under Title V of the IHCIA (25 U.S.C. 1601).
• Check the third choice if you are employed with a Buy Indian
Act Organization (25 U.S.C. 47).
If none of these choices describes your employment, skip this line
and go on to line 9.
Line 9 — American Indian/Alaska Native
IHS gives priority to applications made by American Indians and
Alaska Natives who are members of a federally recognized Tribe.
Submit a copy of an approved Form BIA-4432, Verification of Indian
Preference for Employment in the Bureau of Indian Affairs and the
Indian Health Service with your application.
You must use Form BIA-4432 as follows:
American Indian: Category A — Members of federally recognized
Tribes, bands or communities
Alaska Native: Category D — Alaska Native
Line 10 — IHS Health Professions (Section 104)
Scholarship Recipient
IHS gives priority to applications made by former IHS Health
Professions (Section 104) Scholarship recipients. Please submit a
copy of your completion letter with your application.
Line 11 — Existing Service Obligation
This line requests information on any existing service obligations you
might have. A service obligation is defined as required employment
for a period of time. If you have an existing service obligation as
defined here, check YES and go to line 11a. If you do not have an
existing service obligation, check NO and go to line 12.
Line 11a — If you checked YES, provide details of your existing
service obligation, including the program name and address, the
name and telephone number of a contact person and the terms
of your obligation. You are asked if you are in default of the
obligation — check the appropriate YES or NO box. Finally, enter
the date you will complete your existing service obligation.
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Line 12 — Availability Date
On this line, enter the date you will be available to begin work under
the LRP. You must begin your service period no later than September
30 of the fiscal year in which you’re accepted into the LRP.
Section 2: How to Complete the Educational
and Professional Background Section
This section is to be completed by graduates only and details your
educational and practice experience, if applicable. Information
covered includes training and graduate programs, practice experience
and licensing. If any line does not apply to you, write “NA” (for “not
applicable”) on that line and go on to the next line.
Line 1 — Professional School
Provide the name of the professional school from which you
graduated and the school’s full address. Enter the year you graduated
or will graduate, and the degree you obtained.
Line 2 — Residency/Graduate Program Information
If you have completed a residency or graduate program, check the
YES box and go to line 2a. If you have not completed a residency or
graduate program, check the NO box and go to line 3.
Line 2a — This line requests specific information about your
residency or graduate program. Provide the year you completed
or will complete your residency, school or graduate program, the
name of the residency, school or graduate program, the address,
and the residency/program director’s name and phone number.
Line 2b — For physicians only, enter your specialty. Check the
appropriate box if you are board certified or board eligible. If you
are board certified, enter the year you will be re-certified. List your
sub-specialty if you have one.
Line 3 — Professional Training Locations
This line requests information about your professional training
locations. List each one separately. Provide program name and
address, and the name and telephone number for the program
director. If this does not apply to you, write “NA” on the line and
go to line 4.
Line 4 — Practice Experience
Provide the details of your professional practice experience for the
past five years. If this does not apply to you, write “NA” on the line
and go to line 5.
As you describe your practice experience, include the following
information:
• Location(s) where you’ve practiced
• The nature of the population served
• Number of specialties in the practice
• Any hospital affiliations
• Allocation of clinical practice time to these specialties:
FP/GP, INT, OB/GYN, PED, PSYCH, ER
If you need more space to provide full information for line 4, please
use a continuation sheet. At the top of the page, write Section 2,
Line 4, Practice Experience, Continued, along with your name and
SSN. Attach the sheet to your application.
Line 5 — Last Work Site (If IHS, Tribal or Urban)
For the last site where you worked, provide your job title, the name
of the site director or other official, the site address and telephone
number of the director or official. If this does not apply to you, write
“NA” on the line and go to line 7.
Line 6 — Practice Time Allocation
On this line, enter the current percent of your practice time that is
office-based and hospital/clinic-based and/or spent in administration
and teaching. If this does not apply to you, write “NA” on the line
and go to line 7.
Line 7 — Professional References Information
Provide a minimum of three professional references, including name,
position or title, address and telephone number. This information will
be kept confidential.
Line 8 — Certification by Applicant
This line asks you to sign to certify the accuracy of the information
you are providing in Section 2 of the application. Sign your full name
in ink and enter the date and your SSN.
Section 3: How to Complete the Financial Information Section
This section requests details of qualified loans you want considered
for the LRP. If you have more than one qualified loan, complete
Section 3 forms for each individual loan. Submit copies of loan
and payment documentation (current statements) that have the
following identifying information: SSN, name and address.
Line 1 — Lending Institution/Program
Provide the name and address of the lending institution or the
federal or state program from which you have obtained the loan that
you wish to be considered for repayment.
Line 2 — Date of Loan
Enter the date the loan was originated (mm/dd/yyyy).
Line 3 — Original Loan Amount
Enter the original amount of your loan. This is not the current balance
(see line 4).
Line 4 — Current Loan Balance
Enter the current balance of your loan and the date of the balance.
Line 5 — Payment Amount
Enter the amount of your regular loan payment.
Line 6 — Deferment of Loan
If your loan is in deferment, check the YES box and enter the date
the deferment ends.
Line 7 — Loan Annual Percentage Rate (APR)
Enter the annual percentage rate (APR) of your loan.
Consolidation of Undergraduate and Graduate Educational Loans
The LRP pays for education costs for only one health professions
degree. If you have consolidated your graduate and undergraduate
loans into one loan, LRP will make a determination of what portion of
the consolidated loan will be repaid for successful applicants. Attach
copies of the loan documents for the health professions loans that
were consolidated into the new loan, along with a copy of your
current statement that includes your SSN, your name and address.
Line 8 — Certification by Applicant
This line asks you to sign to certify the accuracy of the information
you are providing in Section 3 of the application. Sign your full name
in ink and enter the date.
Line 9 — Lender Verification
This line asks your lender to sign to certify the accuracy of the
information provided in Section 3 of the application.
Section 4: A Review of the Comparison of Benefits Between
Commissioned Corps and Civil Service (Including Affidavit)
In accordance with P.L. 100-713, Section 108(c)(1), which requires
that the Indian Health Service (IHS) provide information on both the
Commissioned Corps and Civil Service personnel systems, we ask
that you read the attached information. The information will assist
you in making an informed decision as you consider employment
with IHS.
After you have reviewed the personnel systems information,
please sign, date and return the affidavit as part of your
completed application.
Section 5: About the Sample Contract
This section is a sample LRP Contract. You will receive an official
copy to sign and return if you are selected for an award. When
you sign the contract, you will be agreeing to a service obligation
to provide full-time clinical service in an Indian health program for
two years for new recipients, or one year for extensions. Please
read the sample contract thoroughly so that you fully understand
all provisions. If you have any questions regarding the contract,
call the LRP office at (301) 443-3396.
LRP Application Forms
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Application Checklist
The following items make up your complete LRP application. Please refer to the booklet for a detailed description of each section and how to
fill out the requested information.
Section 1:
General Applicant Information
Section 2:
Educational and Professional Background for graduates only
Section 3:
Financial Information, to include lender documentation
Section 4:
Signed Affidavit — Attesting that you’ve read the comparison of IHS personnel systems
Section 5:
Signed Sample Contract
Required Documentation That Must Accompany Your Application:
License to Practice — Provide a copy of full and unrestricted state license
Employment Verification — Provide IHS or Tribal employment verification, Commissioned Corps Orders, SF-50B
Special Circumstances:
American Indian or Alaska Native — Form BIA-4432 (Verification of Indian Preference for Employment in the Bureau of Indian
Affairs and the Indian Health Service)
IHS Health Professions (Section 104) Scholarship Recipient — Completion Letter, if applicable, P.L. 94-437
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
FORM APPROVED
OMB Approval No. 0917-0014
Exp. Date 02/29/2012
Application for the Indian Health Service Loan Repayment Program
Section 1: General Applicant Information
Estimated Average Burden Time to Complete the Application Form:
Public reporting burden for this collection of information is estimated to vary from 60 to 120 minutes per response with an average of
90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. 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.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to: Indian Health Service, Reports Clearance Officer, Attn: PRA (0917-0014), 12300 Twinbrook Parkway, Suite 450, Rockville, MD 20852.
Do not mail completed forms to the above address.
Mail completed applications to: Loan Repayment Program, 801 Thompson Ave., Suite 120, Rockville, MD 20852
(Only complete applications will be considered.)
PERSONAL INFORMATION
1. Name _____________________________________________________________________________________________________
Last First Middle
2. Social Security Number_______________________________________________________________________________________
(Applicants may choose to provide their SSN on a voluntary basis. Should you be awarded an LRP award, you will be required at that time
to provide your SSN for purposes of payroll and payment to you of LRP benefits as a condition of your award.)
3. Home Address ______________________________________________________________________________________________
Number Street Apt. #
City State ZIP Code
4. Home Telephone ____________________________________ Email __________________________________________________
5. Work/School Address ________________________________________________________________________________________
Number Street Apt. or Room #
City State ZIP Code
6. Work/School Telephone ______________________________ Email (if applicable) ________________________________________
7. Date of Birth (mm/dd/yyyy) _____________________________________________________________________________________
Apply Here for Financial Freedom
Section 1 (continued)
8. Are you currently employed with IHS? Yes No
8a. If YES:
Please submit employment verification with application
Current IHS employment is with Commissioned Corps Civil Service
Entry Date _________________________________________ Site/Location ___________________________________________
8b. If NO:
Is your current employment with: (If you check any, you must submit employment verification with your application)
A program conducted under a contract entered into under the Indian Self-Determination Act
A program assisted under Title V of the IHCIA
A Buy Indian Act organization
9. Are you an American Indian or Alaska Native? Yes No
(If YES, please submit Form BIA-4432 with your application)
10. Have you ever received an IHS Health Professions (Section 104) Scholarship? Yes No
(If YES, please submit a copy of your completion letter with your application)
11. Do you have an existing service obligation? Yes No
(For the definition of existing service obligations, see the LRP handbook “How to Apply for your Financial Freedom,” Section 1, page 16, instructions for Line 11.)
11a. If YES:
Name of Program___________________________________________________________________________________________
Address of Program _________________________________________________________________________________________
Contact Person ____________________________________________ Phone __________________________________________
Terms of the obligation ______________________________________________________________________________________
Are you in default of the obligation? Yes No
Date of Completion__________________________________________________________________________________________
12. Date you will be available to begin practice under the LRP ________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
FORM APPROVED
OMB Approval No. 0917-0014
Exp. Date 02/29/2012
Section 2: Educational and Professional Background
(Educational and Professional Background for Graduates Only)
1. Name of Professional School __________________________________________________________________________________
School Address _______________________________________________________________________________________________
Number Street Apt. or Room #
Graduate year and degree obtained_______________________________________________________________________________
2. Have you completed a residency or graduate program? Yes No
(MD, DO, DDS, PedNP, PA, etc.)
2a. Year residency or program was/will be completed_____________________________________________________________
Residency or Program Name __________________________________________________________________________________
Address___________________________________________________________________________________________________
Director of Residency/Program ________________________________________________________________________________
Name Phone
2b. Specialty (for physicians only) _______________________________________________________________________________
Board Certified Board Eligible
Year re-certified (if applicable)____________________
Sub-specialty (if applicable) ______________________
3. If applicable, please list all professional training location(s) separately.
a. Program Name_____________________________________________________________________________________________
Address ____________________________________________________________________________________________________
Program Director’s Name______________________________________________ Phone ___________________________________
b. Program Name_____________________________________________________________________________________________
Address ____________________________________________________________________________________________________
Program Director’s Name______________________________________________ Phone ___________________________________
c. Program Name _____________________________________________________________________________________________
Address ____________________________________________________________________________________________________
Program Director’s Name______________________________________________ Phone ___________________________________
4. If applicable, describe your practice experience over the last five years.
(Include location, nature of population served, number of specialties in the practice, hospital affiliations and allocation of clinical
practice time to FP/GP, INT, OB/GYN, PED, PSYCH, ER. If you need more space, please use continuation sheet, type your name and SSN
at the top of each page, and attach to your application.)
_____________________________________________________________________________________________________________
Apply Here for Financial Freedom
Section 2 (continued)
5. For the last site at which you worked:
Name of Site Director or Official__________________________________________________________________________________
Your Job Title ________________________________________________________________________________________________
Address ____________________________________________________________________________________________________
Phone______________________________________________________________________________________________________
6. Practice Time Allocation: Office-based ________ Hospital/clinic-based_________ Administration ________ Teaching _______
7. Professional References (confidential)
Name Position or Title Address Phone Number
8. Certification by Applicant
I certify that the information given in this application is accurate to the best of my knowledge and belief. I understand that it may
be investigated and that any willfully false representation is sufficient cause for rejection of this application; and if awarded a loan
repayment, that I am liable for repayment of all awarded funds and, further, that any false statement herein may be punished as a
felony under US Code Title 18 Section 1001.
Signature (Sign Your Full Name in Ink) Date
SSN ______________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
FORM APPROVED
OMB Approval No. 0917-0014
Exp. Date 02/29/2012
Section 3: Financial Information
Important: As an applicant, you are applying for loan repayment with the Department of Health and Human Services (HHS), Indian Health
Service (IHS) Loan Repayment Program (LRP) provided for in P.L. 100-713. It is important to submit your financial information promptly to the LRP.
Please complete the following information for each educational loan you submit to the LRP. Include loan and payment documentation with
your application.
1. Name of lending institution and/or federal or state program _______________________________________________________
Address ____________________________________________________________________________________________________
2. Date of Loan (mm/dd/yyyy) ________________________________________
3. Original Amount of Loan $ _______________________________________
4. Current Balance $ ________________ Date of Balance _______________
5. Payment Amount $ _____________________________________________
6. Is loan in deferment? Yes No
IF YES, date deferment ends _______________________________________
7. Annual percentage rate (APR) of loan______%
For consolidation of undergraduate and graduate educational loans
If you have consolidated your loans for undergraduate and graduate costs, you must attach copies of the loan documents for health
professions education costs that were consolidated into a new loan. The LRP pays for education costs for only one health professions
degree, and a determination will be made of the proportion of the consolidated loan that will be paid for successful applicants.
Warning: Any person who knowingly makes a false statement or misrepresentation in this loan repayment transaction, bribes or attempts
to bribe a federal official, fraudulently obtains repayment for a loan under this statute, or commits any other illegal action in connection
with this transaction is subject to a fine or imprisonment under federal statute.
I have read this statement and understand its contents.
Signature Title Date
8. Certification by Applicant
I hereby certify to the accuracy of the above information and apply to enter into an agreement with the Secretary of HHS for repayment
of the educational loans I have listed in Section 3.
I attest that my health educational loans were incurred solely for the purpose of paying for the costs of my education and reasonable living
expenses while attending college/university, and for obtaining a degree in medicine, dentistry, nursing, optometry, pharmacy, podiatry,
mental health or allied health profession.
Signature (Sign Your Full Name in Ink) Date
9. Lender Verification
I understand to the best of my knowledge that the loan identified above is a legally enforceable commercial, state or government
educational loan and its purpose was to pay for the borrower’s cost of completing a degree in medicine, dentistry, nursing, optometry,
pharmacy, podiatry, mental health or allied health profession.
Signature Title Date
Apply Here for Financial Freedom
FORM APPROVED
OMB Approval No. 0917-0014
Exp. Date 02/29/2012
Section 4: Comparison of Benefits Between Commissioned
Corps and Civil Service (Including Affidavit)
We ask that you read the following information on the two personnel systems used by the IHS: The Commissioned Corps and the Civil
Service. IHS is required to provide you with this information, in accordance with P.L. 100-713, Section 108(c)(1), to assist you in making
an informed decision as you consider employment with the IHS. After you have reviewed the personnel systems information, please sign,
date and return the affidavit to the LRP as part of your completed application.
BENEFITS
A. Moving Expenses
COMMISSIONED CORPS
Call to active duty:
Pays to move officer’s family and household goods,
within certain weight limits, from current residence
to duty station.
On duty:
Pays to move officer’s family and household goods,
within certain weight limits, from duty station to
duty station.
On separation or retirement:
Pays to move officer’s family and household goods,
within certain weight limits, from duty station to
home of record or the place from which called to
duty, whichever is farther, or equivalent distance.
CIVIL SERVICE
Call to active duty:
Pays to move physician’s family and
household goods, within certain weight limits,
from current residence to duty station. Other
professions must consult human resources
office in the IHS area where you are hired.
On duty:
Pays to move an employee’s family and
household goods, within certain weight limits,
from duty station to duty station.
On separation or retirement:
Provides no assistance in moving from final
duty station to next place of residence.
B. Vacation Allowances An officer earns 30 days of annual leave per year
(two and a half days per month) from the time
he/she enters on duty. A total of 60 days may be
carried from year to year and may be reimbursed
on the officer’s separation or retirement.
A civil servant earns 13 working days of annual
leave per year (four hours per pay period, 26
pay periods per year for the first three years).
From the fourth year through the 15th, he/
she earns six hours of annual leave per pay
period (20 working days per year). From the
beginning of the 16th year until retirement,
eight hours of annual leave accrues per pay
period (26 working days per year). A total
of 30 days (240 hours) of annual leave may
be carried over from year to year and will be
reimbursed on separation or retirement.
Section 4 (continued)
BENEFITS
C. Sick Leave
COMMISSIONED CORPS
No formal rate of accrual. Sick leave may be
granted when the officer is in need of medical
services or is incapacitated for the performance
of duties by sickness, injury, or pregnancy and
confinement. The leave granting authority or
other responsible official may require a medical
certificate for every period of sick leave in excess
of three days, or for a lesser period when
determined to be necessary.
CIVIL SERVICE
Sick leave is accrued at the rate of four hours
per pay period for the length of employment.
There is no maximum carryover limit.
D. Retirement The Commissioned Corps retirement system is
structured on the basis of a 30-year career. Pay
increases based on length of service continue
throughout an officer’s career. Retired pay is
based on 30 years of service (75 percent of
basic pay). With approval, an officer may retire
after completing 20, but less than 30, years of
active service. To be eligible for consideration for
such retirement, the officer must have 20 years
of creditable service. The Commissioned Corps
retirement system is noncontributory.
The Civil Service retirement system is a three-
tiered contributory comprehensive program
allowing Civil Service employees to control a
large portion of their retirement savings. The
program consists of a base retirement annuity,
Social Security benefits, and a government
matching savings program which allows
employees to invest the savings money
in government securities, the bond market
and/or the common stock market.
E. Health Insurance Officer: US Public Health Service (PHS) officers are
entitled to health care from any uniformed service
medical treatment facility (MTF). Health care
services may be supplemented by other resources
in accordance with uniformed service policies
and procedures.
Dependents: Dependents are entitled to health
care from an MTF on a space-available basis.
TRICARE is the name for the Department of Defense
triple option health care program. Dependents’
dental care can be provided by voluntary
enrollment in the Active Duty Family Member
Dental Plan.
Choice of medical and dental plans range from
traditional fee-for-service plans to prepaid
HMOs. Employee payments and benefits vary
with the plan chosen. Benefits are provided
to employees and dependents on a cost-
sharing basis.
_____________________________________________________________________________________________________________
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Section 4 (continued)
BENEFITS
F. Tax Benefits
COMMISSIONED CORPS
The basic allowance for quarters, variable
housing allowance, and subsistence
allowance are nontaxable. All other
pay is taxable.
CIVIL SERVICE
All pay is taxable.
G. Military Benefits Two years of active duty in the
Commissioned Corps satisfies a person’s
Selective Service obligation.
Civil Service makes no provision here.
H. Air Transportation Officers are eligible to fly on military aircraft
within the US and overseas (foreign travel)
on a “space-available” basis. Their families
may fly overseas only, on the same basis.
Civil Service makes no provision here.
I. Personal Amenities Officers and dependents may use the
commissary, post exchange, transient officer
quarters and other facilities at military bases.
Civil Service makes no provision here.
J. Medical License Must have a full and unrestricted license
in a state.
Must have a full and unrestricted license
in a state.
K. Impact of Loan Repayment
Program on Salary
Participation in the LRP has no impact
on pay.
Participation in the LRP will reduce or
eliminate the Physicians Comparability
Allowance. Physicians should discuss
this with their area recruiters.*
* If you are currently receiving a Physician’s Comparability Allo wance (PCA) bonus, your participation in the LRP may reduce or eliminate your eligibility to receive the PCA bonus.
The PCA bonus is only available to Civil Service employees. For further information, please contact the LRP office.
I certify that I have read the information regarding the Civil Service and Commissioned Corps personnel systems and understand that
I must select one to be employed by the Indian Health Service.
Name (Please Print) Signature Date
Section 5: Sample LRP Contract
This section is a sample LRP contract. You will receive an official
copy to sign and return if you are selected for an award. When
you sign the contract, you will be agreeing to a service obligation
to provide full-time clinical service in an Indian health program for
one year for each year of loan repayment. Please read this sample
contract thoroughly so that you fully understand all provisions. If
you have any questions regarding the contract, call the LRP office
at (301) 443-3396.
Loan Repayment Program — Sample Contract
Section 108 of the IHCIA (P.L. 94-437), as amended, authorizes
the Secretary of Health and Human Services, acting through the
Indian Health Service (IHS), to establish the Indian Health Service
(IHS) Loan Repayment Program (LRP) under which federal, state,
and commercial loans for physicians and other health professionals
may be repaid at a rate not to exceed $20,000 per year. In return
for such loan repayment, recipients must agree to provide full-time
clinical service in an Indian health program for a period of obligated
service equal to one year for each year of loan repayment. Section
108 requires recipients to submit with their applications a written
contract to accept repayment of educational loans and to serve
for the applicable period of obligated service in an Indian health
program. The Secretary shall sign only those contracts submitted
by recipients who are selected for the program.
Section A — Obligations of the Secretary
Subject to the availability of funds appropriated by Congress
for the IHS and the LRP, the Secretary agrees to:
1. M ake payments to the recipient for each year of service of the
lesser of up to $20,000 or the total amount of the recipient’s
eligible health professions educational loans divided by the
number of years of obligated service.
Loans eligible for repayment consist of loan costs identified
by the promissory note indicating the principal, interest, and
related expenses on federal, state, and commercial loans
received by the recipient for tuition expenses; all other
reasonable educational expenses incurred by the recipient; and
reasonable living expenses as determined by the Secretary.
2. Accept the recipient into the IHS or place the recipient with
a Tribe or Tribal or Indian organization provided that the
recipient meets all appropriate employment qualifications.
3. Make loan repayments for each year of obligated service in
which the recipient completes such year of obligated service.
All contracts are for whole years (for example: two whole
years and no fraction or part of a year).
4. Pay, on behalf of the recipient, an amount not less than 20
percent and not more than 39 percent of the recipient’s total
amount of loan repayments to the Internal Revenue Service
for all or part of the increased tax liability.
*3. Recipient’s health profession ____________________________
5. Defer performance of a recipient’s period of obligated service
if the recipient:
a. Receives a degree from a school of medicine, osteopathy,
dentistry, optometry, podiatry, pharmacy, nursing,
psychology, public health, social work, or other health
profession, and
b. Requests a deferment of this period to complete
internship, residency, or other advanced clinical training.
The period of deferment may not exceed:
(1) three years for recipients receiving a degree from a
school of medicine, osteopathy or dentistry
(2) o ne year for recipients receiving a degree from a
school of optometry, podiatry, pharmacy, nursing,
psychology, public health, social work, or other
health profession
The Secretary may, however, extend this period of
deferment if the Secretary determines that the extension
is consistent with the needs of the IHS.
Section B — Obligation of the Recipient
If selected, the recipient agrees:
1. To accept loan repayment provided by the Secretary under
Section A of this contract and to apply such payments only to
outstanding eligible health professions educational loans.
2. To serve in accordance with this Section for two years.
* Must be completed by recipient.
4. In the case of a recipient described in Section 108(b) (1)(A)
(B)(i)(ii), (i.e., In the final year of a course of study or in an
approved graduate training program):
a. To maintain enrollment in a course of study or training,
to maintain an acceptable level of academic standing.
5. To serve for a time period (hereinafter referred to as the “period
of obligated service”) equal to two years or such longer period
as the recipient may agree to serve in the full-time clinical
practice of the recipient’s profession in an Indian health program
to which the recipient may be assigned by the Secretary.
6. To accept assignment, as determined by the Secretary,
for the recipient’s full period of obligated service in a Loan
Repayment Program priority site designated for the recipient’s
profession or specialty by the IHS.
7. To have a current and unrestricted license or certificate,
as necessary for the recipient’s profession, to practice the
recipient’s health profession in a state within the US prior to
commencing obligated service, and maintain that license or
certificate throughout the period of obligated service.
FORM APPROVED
OMB Approval No. 0917-0014
Exp. Date 02/29/2012
Apply Here for Financial Freedom
8. To commence obligated service in accordance with this
contract prior to September 30,____ , and continue
uninterrupted service for the duration of the recipient’s service
obligation period, except as provided in Section G of this
contract or unless recipient’s service obligation is deferred by
the Secretary pursuant to Section A(5) of this contract.
9. To comply with the provisions of Title 42, Code of Federal
Regulations, Part 36, Subpart J, when adopted. Should any
provision of Subpart J be inconsistent with this contract,
the regulatory provision will be controlling.
10. Recipients serving a contract extension under Section E —
Contract Extension have served at least a two-year “period
of obligated service” prescribed in Section 108(f)(1)(B)(iii) of
the IHCIA (P.L. 94-437) as amended by the Indian Health Care
Amendments of 1992 (P.L. 102-573).
11. All LRP recipients must forward in writing any change of
address, financial institution, or employment status within
30 days to the following address:
Indian Health Service Loan Repayment Program
801 Thompson Ave., Suite 120
Rockville, MD 20852
12. Any recipient who is terminated or resigns from their place of
Employment must submit in writing the reason for their non-
employment within 30 days, or their account will be placed
into default and debt collection proceedings will be initiated.
Section C — LRP Contract
The effective date of the LRP contract is calculated from the date
it is signed by the Secretary or his/her delegate, or the IHS Tribal,
Tribal/Urban, or “Buy Indian” health center entry-on-duty date,
whichever is more recent. If already on duty with the IHS or other
Indian health program, calculate from the date of contract; if the
contract is signed prior to reporting to duty, calculate from the
entry-on-duty date.
Section D — LRP Payments
LRP payments will begin within 120 days from the date the LRP
contract becomes effective (calculated from the date the LRP
contract is signed by the Secretary or his/her delegate, or the IHS,
Tribal/Urban organization, or “Buy Indian” health center entry-
on-duty date, whichever is more recent. If already on duty with
the IHS or other Indian health program, calculate from the date of
contract; if contract is signed prior to reporting to duty, calculate
from the entry-on-duty date). Contract extensions will be paid 120
days from initial anniversary date. (See Section E.)
Section E — Contract Extension
1. Recipients may, in accordance with procedures established by
the Secretary, request an extension of this contract.
2. Subject to the availability of funds appropriated by the Congress
of the United States for IHS and the LRP, the Secretary may
approve requests for extension of this contract if:
a. The recipient remains eligible for participation in the
LRP, and
b. The total period of obligated service does not exceed the
number of years that it will take to repay the total amount
of the individual’s outstanding eligible health professions
educational loans up to $20,000 per year under the terms
and conditions of this contract.
Individuals extending a contract initially approved prior
to FY 2000 are eligible to receive the total amount of the
individual’s outstanding health professions educational
loans up to $30,000 per year under the terms and
conditions of this contract.
3. Recipients will be allowed to submit additional Section III
financial information not covered under their initial verification
of debt, as long as the debt to be considered meets the
provisions in the subject section entitled, “For Consolidation of
Undergraduate and Graduate Educational Loans,” and complies
with subsection (2)(b) of this section.
Once the Secretary or his/her authorized representative
approves a contract extension, the period of obligated service
thereunder shall be calculated beginning the first day after
which the recipient’s initial period of obligated service is
completed, if completed the same fiscal year in which the
contract extension is approved and if the recipient remains
on duty after completion of his/her initial period of obligated
service. However, when program funds are exhausted,
the Secretary will not sign and approve contract extension
requests, and no credit will be given for the time served after
the completion of the initial obligated service. LRP recipients
are therefore encouraged to make their contract extension
requests as early as possible, preferably nine months prior to
the completion of their initial period of obligated service.
**4. To serve in accordance with Section E —
Contract Extension for a period of 1 year. _______________
** This provision applies only to those LRP recipients who
have completed their two-year period of obligated
service. Must be initialed by recipient if applying for
a contract extension.
5. All requests for a contract extension must include a payment
history from your lending institution(s) indicating that
maximum payments from the LRP were applied to your
eligible outstanding debt since your acceptance into the LRP.
Section F — Breach of Loan Repayment Contract, Damages
1. If a recipient who has entered into a written contract with the
Secretary and who —
a. Is enrolled in the final year of a course of study, and who —
(1) fails to maintain an acceptable level of academic
standing in the educational institution in which the
recipient is enrolled
(2) voluntarily terminates such enrollment
(3) i s dismissed from such educational institution before
completion of such course of study
(4) fails to apply loan repayments to his/her health
professions educational loans
2. If, for any reason not specified in paragraph (1), a recipient
breaches his/her written contract by failing either to begin,
or complete, the recipient’s period of obligated service in
accordance with Section 108(f), the United States shall
be entitled to recover from the recipient an amount to be
determined in accordance with the following formula:
A = 3Z[(t-s)/t] in which:
a. “A” is the amount the United States is entitled to recover.
b. “Z” is the sum of the amounts paid under this Section
to, or on behalf of, the recipient and the interest on such
amounts which would be payable if, at the time the
amounts were paid, they were loans bearing interest at
the maximum legal prevailing rate, as determined by the
Treasurer of the United States.
c. “t” is the total number of months in the recipient’s period
of obligated service in accordance with Section 108(f).
d. “s” is the number of months of such period served by
such recipient in accordance with this section.
3. Any amount of damages which the United States is entitled
to receive under this contract shall be subject to the United
States within the one-year period beginning on the date of
the breach or such longer period beginning on such date
as shall be specified by the Secretary, and may include all
collection costs including any litigation costs. Amounts not
paid within the one-year period shall be subject to collection
through deductions in Medicare payments pursuant to Section
1892 of the Social Security Act.
4. Unsatisfactory performance by a recipient resulting in the
termination of the recipient’s employment during the
recipient’s period of obligated service shall be considered
a breach of this contract.
Section G — Creditability of Graduate Training Toward
Period of Obligated Service
No credit of time for internship, residency, or other advanced
clinical training will be counted toward satisfying the period
of obligated service incurred under this contract.
Section H — Cancellation, Suspension, Waiver,
and Release of Obligation
1. Any service or payment obligation incurred by the recipient und er
this contract will be cancelled upon the recipient’s death.
2. The Secretary may waive or suspend, in whole or in part, the
recipient’s service obligation incurred under this contract if
compliance by the applicant is impossible or would involve
extreme hardship to the individual and if enforcement of
such obligation with respect to the recipient would be
unconscionable.
3. The Secretary may waive, in whole or in part, the rights of the
United States to recover amounts under this Section in any
case of extreme hardship, as determined by the Secretary.
4. Any obligation of a recipient under the Loan Repayment
Program for payment of damages may be released by a
discharge in bankruptcy under Title 11 of the United States
Code only if such discharge is granted after the expiration
of the five-year period beginning on the date that payment
of such damages is required and only if the bankruptcy
court finds that non-discharge of the obligation would be
unconscionable.
5. All waiver requests to the LRP must be made in writing.
Any LRP waiver approval, denial, or decision will be made
to the recipient in writing within 30 days of the Waiver
Committee’s decision.
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
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Section I — Drug Free Workplace Certification
By signing and submitting this contract, the Indian Health Service Loan Repayment Program recipient certifies, in accordance with 45 CFR
Part 76, as a condition of the contract, he/she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of
a controlled substance while conducting any activity under the contract.
Recipient’s Name (Please Print or Type) Recipient’s Signature Date
I understand that any financial obligation of the United States arising out of this contract and my obligation arising out of
this contract are contingent upon funds being appropriated by Congress for the LRP. The Secretary or his/her authorized
representative must sign this contract before it becomes effective. Further, I understand that any indebtedness I incur prior
to both parties, the Secretary and myself, signing this contract is my responsibility.
Recipient’s Name (Please Print or Type) Recipient’s Signature Date
Secretary of Health and Human Service (or Delegate’s) Signature Date
For Official Use Only
Recipient’s account will be obligated for $________________ and will serve his/her ________ year obligation at the following site.
Official _____________________________________________________ Date _________________________________________________________
Appropriation Number: ________________________________________ CAN _________________________________________________________
Recruiter Information
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Recruiter Offices
Aberdeen Area IHS (Iowa, Nebraska, North Dakota, South Dakota)
115 4th Ave., SE
Aberdeen, SD 57401
Phone: (605) 226-7532
Fax: (605) 226-7321
Alaska Area Native Health Services (Alaska)
4141 Ambassador Dr., Suite 300
Anchorage, AK 99508
Phone: (907) 729-1337, (907) 729-1332 or (800) 684-8361
Fax: (907) 729-1335
Albuquerque Area IHS (Colorado, New Mexico)
5300 Homestead Rd., NE
Albuquerque, NM 87110
Phone: (505) 248-4418
Fax: (505) 248-4938
Bemidji Area IHS (Illinois, Indiana, Michigan,
Minnesota, Wisconsin)
522 Minnesota Ave., NW, Room 119
Bemidji, MN 56601
Phone: (218) 444-0486
Fax: (218) 444-0498
Billings Area IHS (Montana, Wyoming)
2900 Fourth Ave., North
Billings, MT 59101
Phone: (406) 247-7100
Fax: (406) 247-7245 or (406) 247-7230
California Area IHS (California, Hawaii)
650 Capitol Mall, Suite 7-100
Sacramento, CA 95814
Phone: (916) 930-3981 ext. 724
Fax: (916) 930-3952
Eastern United States IHS (Alabama, Arkansas, Connecticut,
Delaware, Florida, Georgia, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Mississippi, New Hampshire, New
Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode
Island, South Carolina, Tennessee, Vermont, Virginia, West
Virginia and District of Columbia)
Nashville Area IHS
711 Stewarts Ferry Pike
Nashville, TN 37214
Phone: (615) 467-1628
Fax: (615) 467-1501
Navajo Area IHS (Arizona, New Mexico, Utah)
PO Box 9020
Window Rock, AZ 86515
Phone: (800) 221-5646
Fax: (928) 871-1383
Oklahoma City Area IHS (Kansas, Missouri, Oklahoma)
5 Corporate Plaza
3625 NW 56th St.
Oklahoma City, OK 73112
Phone: (405) 951-6040 or (800) 722-3357
Fax: (405) 951-3953
Phoenix Area IHS (Arizona, Nevada, Utah)
2 Renaissance Square
40 N. Central Ave.
Phoenix, AZ 85004
Phone: (602) 364-5253
Fax: (602) 364-5358
Portland Area IHS (Idaho, Oregon, Washington)
1220 SW Third Ave., #476
Portland, OR 97204
Phone: (503) 326-3288
Fax: (503) 326-2702
Tucson Area IHS (Arizona, Texas)
7900 S. J Stock Rd.
Tucson, AZ 85746
Phone: (520) 295-2440
Fax: (520) 295-2434
IHS Discipline Chiefs
The IHS Discipline Chief of your particular health discipline will work
with you to explore employment opportunities at IHS priority sites.
Please refer to the following listing of the Discipline Chiefs.
Behavioral Health
Indian Health Service, HQE
801 Thompson Ave., Suite 300
Rockville, MD 20852
Phone: (301) 443-2038
Dentistry
Chief, Dental Program
801 Thompson Ave., TMP 450
Rockville, MD 20852
Phone: (301) 443-0029
www.dentist.ihs.gov
Dietetics/Public Health Nutrition
Indian Health Service, HQE
801 Thompson Ave., TMP 450
Rockville, MD 20852
Phone: (301) 443-0576
Engineering
Indian Health Service, HQE
Environmental Health and Engineering
801 Thompson Ave., TMP 610
Rockville, MD 20852
Phone: (301) 443-1046
Environmental Health/Sanitation
Indian Health Service, HQE
801 Thompson Ave., TMP 610
Rockville, MD 20852
Phone: (301) 443-1054
Medical Records
Indian Health Service, PHX
2 Renaissance Square
40 N. Central Ave., Suite 606
Phoenix, AZ 85004
Phone: (602) 364-5162
Medical Technology
Clinical Applications Administrator – CRSU
Parker Indian Health Center
12033 Agency Rd.
Parker, AZ 85344
Phone: (928) 669-3226
Nursing (Advanced Practice)
Director, DNS
801 Thompson Ave., TMP 450
Rockville, MD 20852
Phone: (301) 443-1840
Nursing (ADN, BSN, MSN)
Nursing
IHS Recruitment Branch
Indian Health Service
801 Thompson Ave., Suite 300
Rockville, MD 20852
Phone: (301) 443-1840
Optometry
Chief, Optometry Program
Standing Rock Indian Hospital
10 River Rd.
Ft. Yates, ND 58538
Phone: (701) 854-8249
Apply Here for Financial Freedom
Pharmacy
Pharmacy
IHS Recruitment Branch
Indian Health Service
801 Thompson Ave., Suite 300
Rockville, MD 20852
Phone: (301) 443-4330
Physician
IHS Recruitment Branch
Indian Health Service
801 Thompson Ave., TMP 450A
Rockville, MD 20852
Phone: (301) 443-4242
Physician Assistant
Physician Assistant Chief
Clinical Consultant, IHS
Cherokee Indian Hospital
Caller Box C-268
Cherokee, NC 28719
Phone: (828) 497-9163, ext. 6499
Podiatry
Phoenix Indian Medical Center
4242 North 16th St.
Phoenix, AZ 85016
Phone: (602) 263-1673
Radiologic Technology/Ultrasonography
Director, Medical Imaging Program
2 Renaissance Square
40 N. Central Ave., Suite 600
Phoenix, AZ 85004
Phone: (602) 364-5166
Rehabilitative Services
Chief Clinical Consultant, Physical Rehabilitation Services
Indian Health Service
Whiteriver Service Unit
Physical Therapy Department
200 Hospital Dr.
Whiteriver, AZ 85941
Phone: (928) 338-3610
