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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0204 can be found here:

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.