Information Collection

Repayment Schedule HRSA-502 1,2

IC 45766 under ICR 201212-0915-003 · OMB 0915-0043.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	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 %

table that charts list of burden
	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

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.