Information Collection

Health Education Assistance Loan (heal) Program - Lenders' Application For Insurance Claim (42 Cfr 60.4)

IC 110103 under ICR 199005-0915-001 · OMB 0915-0036.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	HEALTH EDUCATION ASSISTANCE LOAN (HEAL) PROGRAM - LENDERS' APPLICATION FOR INSURANCE CLAIM (42 CFR 60.4)	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HRSA-510				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,100	1,030	70
Annual IC Time Burden (Hours)	1,100	-1,400	2,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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