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

Documents and Forms
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 1 HEAL Form 539-Disability form539.doc Yes No Fillable Printable

Health Health Care Services

 

75 0
   
Private Sector Businesses or other for-profits
 
   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 90 0 -138 0 0 228
Annual IC Time Burden (Hours) 23 0 -34 0 0 57
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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