Information Collection

HEAL Lender's Application for Insurance Claim

IC 185895 under ICR 200807-0915-002 · OMB 0915-0036.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 510 510 HEAL Lender's Application for Insurance Claim	Form
0036 Tab C instructions.wpd	Instruction
510 510 0036 510form.doc	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	510				Yes	No	Fillable Fileable
Instruction					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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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