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

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

OMB: 0915-0204

IC ID: 6427

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Information Collection (IC) Details

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HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability
 
No Modified
 
Required to Obtain or Retain Benefits
 

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

Health Health Care Services

 

163 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 228 0 0 -17 0 245
Annual IC Time Burden (Hours) 57 0 0 -4 0 61
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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