Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form

ICR 199604-0915-003

OMB: 0915-0036

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0915-0036 199604-0915-003
Historical Active 199303-0915-003
HHS/HSA
Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form
Revision of a currently approved collection   No
Regular
Approved without change 05/31/1996
Retrieve Notice of Action (NOA) 04/16/1996
  Inventory as of this Action Requested Previously Approved
05/31/1999 05/31/1999 05/31/1996
34,325 0 1,125
6,000 0 1,406
0 0 0

This request is for approval of two HEAL forms which are used by holders/servicers of HEAL loans to request Federal assistance in the collection of delinquent loans (HRSA form 513) and to request payment of insurance claims for loans in default (HRSA form 510).

None
None


No

1
IC Title Form No. Form Name
Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form HRSA-510;513

  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 34,325 1,125 0 33,200 0 0
Annual Time Burden (Hours) 6,000 1,406 0 4,594 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
04/16/1996


© 2024 OMB.report | Privacy Policy