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Federal forms, ICRs, and supporting documents

Information Collection

Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form

IC 6323 under ICR 201108-0915-002 · OMB 0915-0036.

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Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 60.35

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 513 Form HRSA-513 Form.doc Yes Yes Fillable Fileable

Health Health Care Services

Health Educational Assistance Loan Program Loan Control Master File  62 FR 5991

13 0
   
Private Sector Businesses or other for-profits
 
   92 %

  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 5,785 0 0 -3,565 0 9,350
Annual IC Time Burden (Hours) 983 0 0 -578 0 1,561
Annual IC Cost Burden (Dollars) 46 0 0 46 0 0

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