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⚠️ Notice: This information collection may be referencing outdated material.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 Form and Instruction
HEAL form 504 Draft HEAL form 504 60 day notice version 8 2018.doc Form and Instruction
Borrower Loan Status Record 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

View Information Collection (IC)

IC Title:	Health Education Assistance Loan (HEAL) Program: Forms	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 8 2018.doc	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Borrower Loan Status Record	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: 15	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	59	-20	79
Annual IC Time Burden (Hours)	9	-4	13
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.