Health Education Assistance Loan (HEAL) Program: Forms

ICR 200307-0915-002

OMB: 0915-0034

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0915-0034 200307-0915-002
Historical Active 200006-0915-001
HHS/HSA
Health Education Assistance Loan (HEAL) Program: Forms
Revision of a currently approved collection   No
Regular
Approved without change 08/11/2003
Retrieve Notice of Action (NOA) 07/02/2003
  Inventory as of this Action Requested Previously Approved
08/31/2006 08/31/2006 08/31/2003
16,400 0 227,552
1,652 0 13,703
0 0 0

The forms are needed for lenders to make application to the HEAL insurance program, to report accurately and timely on loan actions, including transfer of loans to a secondary agent, and to establish the repayment status of borrowers. These reports assist DHHS in diligent administration of the HEAL program which protects the Government's financial interest.

None
None


No

1
IC Title Form No. Form Name
Health Education Assistance Loan (HEAL) Program: Forms HRSA-504

  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 16,400 227,552 0 0 -211,152 0
Annual Time Burden (Hours) 1,652 13,703 0 0 -12,051 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.
07/02/2003


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