Health Education Assistance Loan (HEAL) Program: Forms 504

Health Education Assistance Loan (HEAL) Program: Forms

⚠️ Notice: This information collection may be referencing outdated material.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
Health Education Assistance Loan (HEAL) Program: Forms 504 Form and Instruction
HEAL form 504 Draft HEAL form 504 60 day notice version 5 5 2015.doc Form and Instruction
Borrower Deferment Request Borrower Loan Status Record Layout.docx Form and Instruction
Loan Transfer Record Layout Loan Transfer Record Layout.doc 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

IC Title:	Health Education Assistance Loan (HEAL) Program: Forms 504	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	HEAL form 504	Draft HEAL form 504 60 day notice version 5 5 2015.doc	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Borrower Deferment Request	Borrower Loan Status Record Layout.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Loan Transfer Record Layout	Loan Transfer Record Layout.doc	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	79	-72	151
Annual IC Time Burden (Hours)	13	-10	23
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.