Repayment Schedule HRSA-502 1,2

Health Education Assistance Loan (HEAL)

Documents and Forms

Document Name Document Type
Form 2 Repayment Schedule HRSA-502 1,2 Form and Instruction
2 502-2 HRSA-502-2.docm Form and Instruction
1 502-1 HRSA-502-1.docm Form and Instruction

Information Collection (IC) Details

IC Title:	Repayment Schedule HRSA-502 1,2	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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	2	502-2	HRSA-502-2.docm		Yes	No	Fillable Printable
Form and Instruction	1	502-1	HRSA-502-1.docm		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-15-0044 Health Educational Assistance Loan Program (HEAL) Loan Control Master File	FR Citation: 61 FR 31143

Number of Respondents: 7	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	350	-2,818	3,168
Annual IC Time Burden (Hours)	175	-1,409	1,584
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.