LENDER'S APPLICATION FOR INSURANCE CLAIM ON A HEALTH EDUCATION ASSISTANCE LOAN (HEAL)

ICR 198706-0915-004

OMB: 0915-0036

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0915-0036 198706-0915-004
Historical Active 198401-0915-007
HHS/HSA
LENDER'S APPLICATION FOR INSURANCE CLAIM ON A HEALTH EDUCATION ASSISTANCE LOAN (HEAL)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 10/27/1987
Retrieve Notice of Action (NOA) 06/25/1987
  Inventory as of this Action Requested Previously Approved
06/30/1990 06/30/1990
70 0 0
2,500 0 0
0 0 0

LENDERS USE THE APPLICATION TO REQUEST FEDERAL INSURANCE PAYMENT ON A DEFAULTED HEALTH LOAN. LENDERS SUBMITS THE FOR RECORDING THE REASON FOR THE CLAIM, BORROWER'S ADDRESS, NUMBER OF LOAN AND PAYMENT STATUS. THE PHS USES THIS FORM TO DETERMINE IF THE LENDER HAS COMPLIED WITH STATUTORY AND REGULATORY REQUIREMENTS.

None
None


No

1
IC Title Form No. Form Name
LENDER'S APPLICATION FOR INSURANCE CLAIM ON A HEALTH EDUCATION ASSISTANCE LOAN (HEAL) HRSA-510

  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 70 0 0 0 70 0
Annual Time Burden (Hours) 2,500 0 0 0 2,500 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.
06/25/1987


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