Health Education Assistance Loan (HEAL) Program Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0043 can be found here:

Documents and Forms

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Information Collection (IC) Details

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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:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HRSA-512	Yes	Yes
Form	HRSA-500-3	Yes	Yes
Form	HRSA-50201	Yes	Yes
Form	HRSA-500-2	Yes	Yes
Form	HRSA-502-2	Yes	Yes
Form	HRSA-500-1	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 748	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 1 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	23,946	-26,786	50,732
Annual IC Time Burden (Hours)	12,005	-13,419	25,424
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.