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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HEAL 539	Form and Instruction	Modified	Available
HEAL 539	Form and Instruction	Modified	Repair queued
HEAL 539	Form and Instruction	Modified	Available
HEAL 539	Form and Instruction	Modified	Repair queued
Form 539 Question Responses v0_1.docx	Supplementary Document	Uploaded 2022-11-29	Repair queued
1845-0124 HEAL Form 539 Supporting Statement 30D.docx	Supporting Statement A	Uploaded 2022-11-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6427	HEAL 539	Form and Instruction	Modified	N/A
6427	HEAL 539	Form and Instruction	Modified
222115	HEAL 539	Form and Instruction	Modified	N/A
222115	HEAL 539	Form and Instruction	Modified

ICR Details

OMB Control No: 1845-0124	ICR Reference No: 202209-1845-001
Status: Historical Active	Previous ICR Reference No: 201907-1845-004
Agency/Subagency: ED/FSA	Agency Tracking No: ED-2022-SCC-0110
Title: HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/20/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/05/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2026	36 Months From Approved	01/31/2023
Responses	82	0	78
Time Burden (Hours)	22	0	20
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for an extension of the OMB approval of the information collection associated with the form for the Health Education Assistance Loan (HEAL) Program, Physician’s Certification of Borrower’s Total and Permanent Disability, currently approved under OMB Control Number 1845-0124. The form is HEAL 539. A borrower and the borrower's physician must complete this form. The borrower then submits the form and additional information to the lending institution (or current holder of the loan) who in turn forwards the form and additional information to the Secretary for consideration of discharge of the borrower's HEAL loans. The form provides a uniform format for borrowers and lenders to use when submitting a disability claim.

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Authorizing Statute(s): PL: Pub.L. 113 - 76 525 Name of Law: Consolidated Appropriation Act, 2014
  

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:
	87 FR 54987	09/08/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 74413	12/05/2022
Did the Agency receive public comments on this ICR? Yes

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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
HEAL 539	N/A	N/A
HEAL 539	N/A	N/A

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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	82	78	0	0	4	0
Annual Time Burden (Hours)	22	20	0	0	2	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: We are requesting an extension to the OMB information collection 1845-0124. There have been no changes to the statute or regulations. We are showing a slight increase to 22 burden hours (+2) increases and responses (+4) based on changes in the number of participants.

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Annual Cost to Federal Government: $6,525

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.     No

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.     No

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: 12/05/2022

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