Information Collection

Health Education Assistance Loan (HEAL) Program: Forms

IC 43609 under ICR 201406-1845-005 · OMB 1845-0128.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0128 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Health Education Assistance Loan (HEAL) Program: Forms Form and Instruction
1 HRSA 504 HRSA-504.doc Form and Instruction
2 HRSA 508 HRSA-508 BorDefer.docx Form and Instruction
BLS_Tape_Specs.pdf BLS_Tape_Specs IC Document
Loan_Pur_Consol_Tape_Specs.doc Loan_Pur_Consol_Tape_Specs IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Education Assistance Loan (HEAL) Program: Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	HRSA 504	HRSA-504.doc		Yes	No	Fillable Printable
Form and Instruction	2	HRSA 508	HRSA-508 BorDefer.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 73	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	151	-83	234
Annual IC Time Burden (Hours)	23	-12	35
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
BLS_Tape_Specs	BLS_Tape_Specs.pdf	07/31/2012
Loan_Pur_Consol_Tape_Specs	Loan_Pur_Consol_Tape_Specs.doc	07/31/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.