HEAL PROMISSORY NOTE - (VARIABLE AND FIXED RATES)

ICR 198410-0915-005

OMB: 0915-0086

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
165570 Migrated
ICR Details
0915-0086 198410-0915-005
Historical Active 198406-0915-008
HHS/HSA
HEAL PROMISSORY NOTE - (VARIABLE AND FIXED RATES)
No material or nonsubstantive change to a currently approved collection   No
Emergency 10/26/1984
Approved with change 10/26/1984
Retrieve Notice of Action (NOA) 10/26/1984
  Inventory as of this Action Requested Previously Approved
01/31/1986 01/31/1986 01/31/1986
13,500 0 13,500
7,200 0 7,200
0 0 0

EXECUTING THIS AGREEMENT CREATES A BINDING OBLIGATION ON HEAL LOAN BORROWERS TO REPAY LENDER OR SUBSEQUENT HOLDER ANY MONIES ADVANCED AND OTHER FEES AND CHARGES PERMITTED BY FEDERAL REGULATION. EXECTUTED NOTE ESTABLISHES LEGAL RIGHT TO COLLECT ANY AMOUNT NOT PAID WHEN DUE. NOTICE TO BORROWERS OF TERMS FOR REPAYMENT.

None
None


No

1
IC Title Form No. Form Name
HEAL PROMISSORY NOTE - (VARIABLE AND FIXED RATES) HRSA 500-1

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 13,500 13,500 0 0 0 0
Annual Time Burden (Hours) 7,200 7,200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/26/1984


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