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

Documents and Forms

Document Name Document Type
HEAL Lender's Application for Insurance Claim Form (Form 510) Form
Instructions for HEAL form 510 Draft 2023.docx Instruction
Instructions for HEAL form 510 Draft 2023.docx Instruction
Form 510 HEAL form 510 Draft 2023.docx Form
Form 510 HEAL form 510 Draft 2023.docx Form

Information Collection (IC) Details

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 2023.docx		Yes	No	Fillable Printable
Instruction			Instructions for HEAL form 510 Draft 2023.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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	375	375

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.