Information Collection

HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability

IC 6427 under ICR 200403-0915-002 · OMB 0915-0204.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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Information Collection (IC) Details

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IC Title:	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	539				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 211	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	282	-69	351
Annual IC Time Burden (Hours)	71	-17	88
Annual IC Cost Burden (Dollars)	2,000	0	2,000

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.