HEAL Form 539 - Private Sector

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0124 can be found here:

Documents and Forms

Document Name Document Type
Form HEAL Form 539 HEAL Form 539 - Private Sector Form and Instruction
HEAL Form 539 PHYSICIAN'S CERTIFICATION OF BORROWER'S TOTAL AND PERMAN 1845-0124 HEAL Form 539 updated draft for 30 day clearance review.doc Form and Instruction

Information Collection (IC) Details

IC Title:	HEAL Form 539 - Private Sector	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HEAL Form 539	PHYSICIAN'S CERTIFICATION OF BORROWER'S TOTAL AND PERMANENT DISABILITY	1845-0124 HEAL Form 539 updated draft for 30 day clearance review.doc		Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

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

Number of Respondents: 50	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	-40	90
Annual IC Time Burden (Hours)	15	-8	23
Annual IC Cost Burden (Dollars)	0	0	0

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.