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HEAL Lender's Application for Insurance Claim Form (Form 510)
Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form
OMB: 1845-0127
IC ID: 185895
OMB.report
ED/FSA
OMB 1845-0127
ICR 202003-1845-001
IC 185895
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0127 can be found here:
2023-06-05 - Extension without change of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
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
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
75
0
0
-200
0
275
Annual IC Time Burden (Hours)
38
0
0
-100
0
138
Annual IC Cost Burden (Dollars)
375
0
0
-1,550
0
1,925
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.