Information Collection

Health Education Assistance Loan (HEAL) Program: Physician's Certification of Borrower's Total and Permanent Disability

IC 6425 under ICR 199802-0915-001 · OMB 0915-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0204 can be found here:

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Information Collection (IC) Details

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IC Title:	Health Education Assistance Loan (HEAL) Program: Physician's Certification of Borrower's Total and Permanent Disability	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-539				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 232	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	300	121	53	126
Annual IC Time Burden (Hours)	175	100	44	31
Annual IC Cost Burden (Dollars)	1,000	-587,000	0	588,000

Documents for IC

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