Health Education Assistance Loan (HEAL) Program: Forms

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.