Skip to Main Content

HRSA Electronic Handbooks

Dental Faculty Development and Loan Repayment Program

pdf
  • Health Resources and Services Administration
  • Academic Year: 2025-2026
  • Bureau of Health Workforce
  • OMB Number: 0906-0086
  • Annual Performance Report
  • OMB Expiration Date: 03/31/2027

IND-GEN: Individual Characteristics

The IND-GEN form captures individual-level information about students, faculty, or other types of awardees who either received direct financial support (e.g., loans, loan repayment, scholarships, or stipends) through a HRSA grant or participated in specific types of HRSA-supported training. Please complete this form in its entirety. If you have any questions about how to complete this form, please refer to the instruction manual and/or contact your Government Project Officer. If you wish to view data that were submitted in the prior reporting period, click on the ‘View Prior Period Data’ link and a read-only version of your most recent prior performance report will pop-up in a new screen. Also, records about ongoing training programs or activities from the prior reporting period will auto-populate into this form and are identified as ‘Prior Records’ under the column labeled "Record Status".


Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period?
(complete IND-GEN)(click Save and Validate button to proceed to the next form)
No.Record StatusTrainee Unique ID
(2)
Block 1		NPI Number
(2a)		Select Individual's Training or Awardee Category
(3)
Block 2		Select Individual's Enrollment / Employment Status
(4)
Block 3		Select Individual's Sex
(5a)		Enter Year of Birth
(6a)		Select Individual's Ethnicity
(7)
Block 6		Select Individual's Race
(8)
Block 7		Select Whether Individual is from a Rural Residential Background
(9)
Block 8		Select Whether Individual is from a Disadvantaged Background
(10)
Block 9		Select Individual's Veteran Status
(11)
Block 10		Select Whether Individual Received a Financial Award from this Grant?
(12)
Block 11		Enter Individual's Financial Award Amount (BHW funds only)Enter # of Academic Years the Individual has Received BHW Funding
(22)
Block 12		Enter Balance of Individual's Loan
(23)
Block 13		Select Whether Loan Remains in Good Standing and is not in Default
(23a)		Select any HHS Priority Topic Area on which an Individual Received Training
(26b)
Block 15		Select Individual's Profession
(26c)		Select Individual's Primary Discipline/Specialty
(26d)		Select Whether Individual Received Training in a Community-based Setting
(27ab)		Training in TelehealthSelect Whether Individual Left the Program Before Completion
(36)
Block 21		Select Whether Individual Graduated/Completed the Program
(37)
Block 22		Select Degree Earned
(38)
Block 22a		Enter the % FTE Individual Spent on the Following RolesEmployment DataRecord Moved From INDGEN-PY
(120)		Option(s)
Loan Repayment
(18)
Block 11		Direct Financial Support
(20a)
Block 11		Academic Year Total (Auto-Populates)
(21b)
Block 11		Select Whether Individual Received Training
(27d)		Research
(40)
Block 24a		Teaching
(41)
Block 24b		Administration
(42)
Block 24c		Clinical
(43)
Block 24d		Select the Individual’s Current Employment/Training Status
(56)		Select the Individuals Current Employment/Training Activities
(56ab)		Enter Zip Code
(57)		City (Auto-Populates)
(58)		State (Auto-Populates)
(59)		Select Employment Type
(60)		Select Individual's Employment Location Settings
(61)		Select Whether Your Organization Hired this Individual
(65)		Select Whether a Partner Organization Hired this Individual
(66)
Page Total
Form Total

Scroll to top