Information Collection

Health Education Assistance Loan (HEAL) Program: Forms

IC 43609 under ICR 200908-0915-001 · OMB 0915-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0034 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HRSA 504 Health Education Assistance Loan (HEAL) Program: Forms	Form
HRSA 504 Lender's Application for Contract of Federal Loan Insura HRSA-504.doc	Form
HRSA 508 Borrower's Deferment Request HRSA-508.doc	Form
BLS_Tape_Specs.pdf Borrower Loan Status Updates- tape specifications	IC Document
Loan_Pur_Consol_Tape_Specs.doc Loan Purchases & Consolidation- tape specifications	IC Document

IC Title:

Health Education Assistance Loan (HEAL) Program: Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	HRSA 504	Lender's Application for Contract of Federal Loan Insurance	HRSA-504.doc		Yes	No	Fillable Printable
Form	HRSA 508	Borrower's Deferment Request	HRSA-508.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 123

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	234	-5,015	5,249
Annual IC Time Burden (Hours)	35	-382	417
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Borrower Loan Status Updates- tape specifications	BLS_Tape_Specs.pdf	07/24/2009
Loan Purchases & Consolidation- tape specifications	Loan_Pur_Consol_Tape_Specs.doc	07/24/2009

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