Health Education Assistance Loan (HEAL) Program: Forms

Forms and Documents

Document Name	Status
Health Education Assistance Loan (HEAL) Program: Forms 504 Form and Instruction	Modified
HEAL form 508 Form and Instruction	New
60D Notice Comment Summary.docx Supplementary Document	2015-07-30
1845-0128 Supporting Statement 30 day notice July 2015.docx Supporting Statement A	2015-07-30

IC Document Collections

IC ID	Document Title	Status
43609	Health Education Assistance Loan (HEAL) Program: Forms 504 Form and Instruction	Modified
216521	HEAL form 508 Form and Instruction	New

ICR Details

OMB Control No: 1845-0128	ICR Reference No: 201505-1845-002
Status: Historical Active	Previous ICR Reference No: 201406-1845-019
Agency/Subagency: ED/FSA	Agency Tracking No:
Title: Health Education Assistance Loan (HEAL) Program: Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/22/2015
	Date Received in OIRA: 08/05/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	36 Months From Approved	10/31/2015
Responses	167	0	151
Time Burden (Hours)	24	0	23
Cost Burden (Dollars)	0	0	0

---

Abstract: The Health Education Assistance Loan (HEAL) forms are required for lenders to make application to the HEAL insurance program, to report accurately and timely on loan actions, including transfer of loans to a secondary agent, and to establish the repayment status of borrowers who qualify for deferment of payments using form 508. The reports assist in the diligent administration of the HEAL program, protecting the financial interest of the federal government.

---

Authorizing Statute(s): US Code: 42 USC 292 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 27941	05/15/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 46569	08/05/2015
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
HEAL form 508	N/A	HEAL form 508
Health Education Assistance Loan (HEAL) Program: Forms 504	N/A, N/A, N/A	HEAL form 504 ,   Borrower Deferment Request ,   Loan Transfer Record Layout

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	167	151	0	16	0	0
Annual Time Burden (Hours)	24	23	0	1	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: ED is requesting a revision to the currently approved information collection for HEAL forms 504 and 508 as well as the data sets, Borrower Loan Status Updates and Loan Purchases and Consolidation. ED is increasing the number of hours by one hour to a total of 24, the number of respondents by 23 and the number of responses by 16. These slight program changes are due to the continued use of the deferment form by eligible borrowers and the continued use of the required reporting mechanisms by HEAL loan holders.

---

Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/05/2015

---