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

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

OMB: 0915-0036

IC ID: 6321

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Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HRSA-513 Yes Yes
Form HRSA-510 Yes Yes


    

20 0
   
Private Sector Businesses or other for-profits
 
   87 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 26,700 0 2,547 -10,172 0 34,325
Annual IC Time Burden (Hours) 4,958 0 348 -1,390 0 6,000
Annual IC Cost Burden (Dollars) 11,000 0 4,000 0 0 7,000

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

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