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

ICR 201306-0915-004

OMB: 0915-0204

Federal Form Document

Forms and Documents
ICR Details
0915-0204 201306-0915-004
Historical Active 201006-0915-002
HHS/HSA 19768
HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability
Extension without change of a currently approved collection   No
Regular
Approved with change 09/17/2013
Retrieve Notice of Action (NOA) 06/21/2013
  Inventory as of this Action Requested Previously Approved
09/30/2016 36 Months From Approved 09/30/2013
90 0 228
23 0 57
0 0 0

The forms certifies that the HEAL borrower meets the total and permanent disability requirements for cancellation of the obligation to repay HEAL student loans. The information collected on the certification and disability form is essential for proper administration of the HEAL program.

US Code: 42 USC 714 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  78 FR 18988 03/28/2013
78 FR 35286 06/12/2013
No

1
IC Title Form No. Form Name
HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability 1 HEAL Form 539-Disability

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 90 228 0 -138 0 0
Annual Time Burden (Hours) 23 57 0 -34 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The decrease of 35 burden hours is due to the following program adjustments: Borrower: The number of disability claims decreased from 75 to 30. This accounts for a 225 minute decrease. (45 fewer claims x 5 minutes per claim = -225 minutes). Loan/Holder: The number of lenders holding HEAL loans increased from 13 lenders to 15 lenders. The number of disability claims submitted decreased from 75 to 30. This represents a burden decrease of 450 minutes. (45 fewer claims x 10 minutes per claim = -450 minutes). Physician: The number of cases reviewed by physicians decreased from 75 to 30. This represents a burden decrease of 22.5 hours (45 fewer claims x 22.5 minutes = -22.5 burden hours).

$12,823
No
No
No
No
No
Uncollected
Jodi Duckhorn 301 443-1984

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/21/2013


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