Information Collection

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

IC 6427 under ICR 201006-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 539 HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability	Form and Instruction
539 HEAL Form 539-Disability form539.doc	Form and Instruction

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: 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 and Instruction	539	HEAL Form 539-Disability	form539.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 163

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	228	-17	245
Annual IC Time Burden (Hours)	57	-4	61
Annual IC Cost Burden (Dollars)	0	0	0

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.