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

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 can be found here.

HEAL 539

Federal Enterprise Architecture: Education - Higher Education

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.