HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability

Forms and Documents

Document	Type	Status	Availability
Form HEAL Form 539 HEAL Form 539 - Private Sector	Form and Instruction	Modified	Repair queued
Form HEAL Form 539 HEAL Form 539 - Public sector	Form and Instruction	New	Repair queued
1845-0124 Supporting Statement 30 day filing 2016 rev.docx	Supporting Statement A	Uploaded 2016-09-09	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
6427	HEAL Form 539 - Private Sector	Form and Instruction	Modified
222115	HEAL Form 539 - Public sector	Form and Instruction	New

ICR Details

OMB Control No: 1845-0124	ICR Reference No: 201606-1845-002
Status: Historical Active	Previous ICR Reference No: 201406-1845-016
Agency/Subagency: ED/FSA	Agency Tracking No:
Title: HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/17/2016
	Date Received in OIRA: 09/14/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved	11/30/2016
Responses	70	0	90
Time Burden (Hours)	18	0	23
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a request for an extension of OMB approval of information collection requirements associated with the form for the Health Education Assistance Loan (HEAL) Program, Physician’s Certification of Borrower’s Total and Permanent Disability currently approved under OMB No. 1845-0124. The form is HEAL Form 539. A borrower and the borrower's physician must complete this form. The borrower then submits the form and additional information to the lending institution (or current holder of the loan) who in turn forwards the form and additional information to the Secretary for consideration of discharge of the borrower's HEAL loans. The form provides a uniform format for borrowers and lenders to use when submitting a disability claim.

---

Authorizing Statute(s): US Code: 42 USC 714 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:
	81 FR 41529	06/27/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 62735	09/12/2016
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
HEAL Form 539 - Private Sector	HEAL Form 539	PHYSICIAN'S CERTIFICATION OF BORROWER'S TOTAL AND PERMANENT DISABILITY
HEAL Form 539 - Public sector	HEAL Form 539	PHYSICIAN'S CERTIFICATION OF BORROWER'S TOTAL AND PERMANENT DISABILITY

---

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	70	90	0	0	-20	0
Annual Time Burden (Hours)	18	23	0	0	-5	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is an extension of the collection since there have been no changes in the regulations or statute. There is a decrease in burden hours due to a decrease in the use of the form. This decrease is considered an adjustment.

---

Annual Cost to Federal Government: $12,823

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: 09/14/2016

---