Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form

Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form

OMB: 1845-0127

IC ID: 6323

Information Collection (IC) Details

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Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form 2040
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 60.35

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 513 Form Final of HEAL form 513 6 19 2014.doc Yes Yes Fillable Fileable

Health Health Care Services

Health Educational Assistance Loan Program Loan Control Master File  62 FR 5991

13 0
   
Private Sector Businesses or other for-profits
 
   92 %

  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 5,785 0 0 0 0 5,785
Annual IC Time Burden (Hours) 983 0 0 0 0 983
Annual IC Cost Burden (Dollars) 46 0 0 0 0 46

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