Information Collection

Health Education Assistance Loan (HEAL) Program: Forms

IC 43609 under ICR 201406-1845-019 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 Health Education Assistance Loan (HEAL) Program: Forms	Form and Instruction
1 HRSA 504 Final of form HEAL-504 6 19 2014.doc	Form and Instruction
2 HRSA 508 Final of form HEAL-508 6 19 2014.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

IC Title:

Health Education Assistance Loan (HEAL) Program: Forms

Agency IC Tracking Number:

2041

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	HRSA 504	Final of form HEAL-504 6 19 2014.doc		Yes	No	Fillable Printable
Form and Instruction	2	HRSA 508	Final of form HEAL-508 6 19 2014.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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	151	151
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.