Information Collection

HEAL Lender's Application for Insurance Claim Form (Form 510)

IC 185895 under ICR 202003-1845-001 · OMB 1845-0127.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0127 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HEAL Lender's Application for Insurance Claim Form (Form 510)	Form
Instructions for HEAL form 510 Draft 2020.docx	Instruction
Form 510 HEAL form 510 Draft 2020.docx	Form

IC Title:

HEAL Lender's Application for Insurance Claim Form (Form 510)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 60.40

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	Form 510	HEAL form 510 Draft 2020.docx		Yes	No	Fillable Printable
Instruction			Instructions for HEAL form 510 Draft 2020.docx		Yes	No	Printable Only

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: Health Education Assistance Loan

FR Citation: 83 FR 40264

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 92 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	75	-200	275
Annual IC Time Burden (Hours)	38	-100	138
Annual IC Cost Burden (Dollars)	375	-1,550	1,925

Documents for IC

table that charts IC Documents
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.