OMB control number
HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability
OMB 1845-0124 · ED/FSA.
OMB 1845-0124
This is a request for an extension of OMB approval of information collection requirements 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 No. 1845-0124. The form is HEAL Form 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.
The latest form for HEAL Program: Physician's Certification of Borrower's Total and Permanent Disability expires 2023-01-31 and is listed under ICR 201907-1845-004.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 HEAL 539 | Form and Instruction |
| HEAL 539 | Form and Instruction |
| Form 539 Question Responses v0_1.docx | Supplementary Document |
| 1845-0124 HEAL Form 539 Supporting Statement 30D.docx | Supporting Statement A |
 HEAL 539 |
Form and Instruction |
| HEAL 539 |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202209-1845-001 | Extension without change of a currently approved collection | 2022-12-05 | Approved without change | |
| 201907-1845-004 | Extension without change of a currently approved collection | 2019-10-16 | Approved without change | |
| 201606-1845-002 | Extension without change of a currently approved collection | 2016-09-14 | Approved without change | |
| 201406-1845-016 | No material or nonsubstantive change to a currently approved collection | 2014-06-24 | Approved without change | |
| 201406-1845-001 | Extension without change of a currently approved collection | 2014-06-02 | Approved with change |
OMB Details
HEAL 539
Federal Enterprise Architecture: Education - Higher Education
| Form | Name | Electronic access | Type |
|---|
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.