Information Collection

Health Education Assistance Loan (heal) Program - Forms

IC 110125 under ICR 198604-0915-001 · OMB 0915-0043.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

HEALTH EDUCATION ASSISTANCE LOAN (HEAL) PROGRAM - FORMS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HRSA 500	No	No
Form	(1 & 2), 502	No	No
Form	(1 & 2)	No	No
Form	512	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 466

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	54,864	502	51,854	2,508
Annual IC Time Burden (Hours)	30,693	270	27,915	2,508
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.