HEAL Lender's Application for Insurance Claim

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0127 can be found here:

Documents and Forms

Document Name Document Type
HEAL Lender's Application for Insurance Claim Form
Instructions for HEAL form 510 July 2014 508 approved.docx Instruction
Form 510 Final of HEAL form 510 6 19 2014.docx Form

Information Collection (IC) Details

IC Title:	HEAL Lender's Application for Insurance Claim	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 60.40

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	Form 510	Final of HEAL form 510 6 19 2014.docx		Yes	No	Fillable Fileable
Instruction			Instructions for HEAL form 510 July 2014 508 approved.docx		Yes	No	Printable Only

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: Health Education Assistance Loan	FR Citation: 79 FR 36299

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	364	364
Annual IC Time Burden (Hours)	182	182
Annual IC Cost Burden (Dollars)	2,548	2,548

Documents for IC

Title	Document	Date Uploaded
No associated records found

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