Health Education Assistance Loan (HEAL) Program: Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HEAL Form 504 Contract for Federal Loan Insurance	Form and Instruction	Modified	Available
Application for Contract of Federal Loan Insurance (HEAL Form 504)	Form and Instruction	Modified	Repair queued
HEAL Form 508 Borrower Deferment Request	Form and Instruction	Modified	Available
Borrower Deferment Request (HEAL Form 508)	Form and Instruction	Modified	Repair queued
1845-0128 Supporting Statement 2021 30D rev.docx	Supporting Statement A	Uploaded 2021-08-24	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43609	Application for Contract of Federal Loan Insurance (HEAL Form 504)	Form and Instruction	Modified	HEAL Form 504 Contract for Federal Loan Insurance
43609	Application for Contract of Federal Loan Insurance (HEAL Form 504)	Form and Instruction	Modified
216521	Borrower Deferment Request (HEAL Form 508)	Form and Instruction	Modified	HEAL Form 508 Borrower Deferment Request
216521	Borrower Deferment Request (HEAL Form 508)	Form and Instruction	Modified

ICR Details

OMB Control No: 1845-0128	ICR Reference No: 202106-1845-002
Status: Historical Active	Previous ICR Reference No: 201808-1845-004
Agency/Subagency: ED/FSA	Agency Tracking No: ED-2021-SCC-0094
Title: Health Education Assistance Loan (HEAL) Program: Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/13/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/30/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2024	36 Months From Approved	12/31/2021
Responses	21	0	69
Time Burden (Hours)	4	0	11
Cost Burden (Dollars)	0	0	0

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Abstract: The HEAL form 504 is required for lenders to make applications to the HEAL insurance program, to report accurately and timely on loan actions, including transfer of loans to a secondary agent, and to establish the repayment status of borrowers who qualify for deferment of payments. The HEAL form 508 is required for HEAL borrowers to request deferment of payment of their loan under specific conditions. This collection is removing the datasets previously included in this collection due to the decrease in the number of users.

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Authorizing Statute(s): US Code: 42 USC 292 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 32902	06/23/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 48408	08/30/2021
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for Contract of Federal Loan Insurance (HEAL Form 504)	NA	HEAL Form 504 Contract for Federal Loan Insurance
Borrower Deferment Request (HEAL Form 508)	NA	HEAL Form 508 Borrower Deferment Request

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ICR Summary of Burden

table that charts list 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	21	69	0	0	-48	0
Annual Time Burden (Hours)	4	11	0	0	-7	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: The Department is requesting a revision of the currently approved information collection for HEAL forms 504 and 508. We are decreasing the total number of respondents to 21 from 69 (-48), responses to 21 from 69 (-48) and burden hours to 4 from 11 (-7). These changes are due to a decrease in HEAL servicer participation and the reduced number of borrowers who were in a deferred status at the end of FY20.

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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Common Form ICR:  No

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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: 08/30/2021

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