Health Education Assistance Loan (HEAL) Program Forms

ICR 199708-0915-003

OMB: 0915-0043

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
6325 Migrated
ICR Details
0915-0043 199708-0915-003
Historical Active 199407-0915-001
HHS/HSA
Health Education Assistance Loan (HEAL) Program Forms
Extension without change of a currently approved collection   No
Regular
Approved without change 09/30/1997
Retrieve Notice of Action (NOA) 08/08/1997
  Inventory as of this Action Requested Previously Approved
10/31/2000 10/31/2000 09/30/1997
23,946 0 50,732
12,005 0 25,424
0 0 0

The information from these forms is essential for sound and responsible program management. The repayment schedule establishes the amounts, number, and due dates of payments. The promissory note provides legal documentation of the loan. The lender's call report enables the Department to monitor outstanding HEAL loans.

None
None


No

1
IC Title Form No. Form Name
Health Education Assistance Loan (HEAL) Program Forms HRSA-500-1, HRSA-500-2, HRSA-500-3, HRSA-50201, HRSA-502-2, HRSA-512

  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 23,946 50,732 0 0 -26,786 0
Annual Time Burden (Hours) 12,005 25,424 0 0 -13,419 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.
08/08/1997


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