HEAL Lender's Application for Insurance Claim

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 510 HEAL Lender's Application for Insurance Claim Form
0036 Tab C instructions.wpd Instruction
510 510 0036 510form.doc Form

Information Collection (IC) Details

IC Title:	HEAL Lender's Application for Insurance Claim	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 60.40

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	510	510	0036 510form.doc		Yes	No	Fillable Fileable
Instruction			0036 Tab C instructions.wpd		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Health Educational Assistance Loan Program Loan Control Master File	FR Citation: 62 FR 5991

Number of Respondents: 17	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	425	425
Annual IC Time Burden (Hours)	213	213
Annual IC Cost Burden (Dollars)	3,050	3,050

Documents for IC

Title	Document	Date Uploaded
No associated records found

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