Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form

ICR 201406-1845-004

OMB: 1845-0127

Federal Form Document

ICR Details
1845-0127 201406-1845-004
Historical Active 200807-0915-002
ED/FSA
Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form
Extension without change of a currently approved collection   No
Regular
Approved without change 06/02/2014
Retrieve Notice of Action (NOA) 06/02/2014
  Inventory as of this Action Requested Previously Approved
10/31/2014 36 Months From Approved
6,149 0 9,775
1,165 0 1,774
2,594 0 3,050

The HEAL Lender's Application for Insurance Claim and the Request for Collection Assistance forms are used in the administration of the Health Education Assistant Loan (HEAL) program. The HEAL program provided federally insured loans to students in certain health professions discliplines, and these forms are used in the administration of the HEAL program. The Lender's Application for Insurance Claim is used by the lending institution to request payment of a claim by the Federal Government. The Request for Collection Assistance form is used by the lender to request pre-claim assistance from the Department of Health and Human Services.

PL: Pub.L. 105 - 392 101 Name of Law: Health Professions Education and Financial Assistance Programs
   PL: Pub.L. 102 - 408 101 Name of Law: Health Professions Education Amendments of 1992
  
None

Not associated with rulemaking

  76 FR 30948 05/27/2011
76 FR 51042 08/17/2011
No

  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 6,149 9,775 0 0 -3,626 0
Annual Time Burden (Hours) 1,165 1,774 0 0 -609 0
Annual Cost Burden (Dollars) 2,594 3,050 0 0 -456 0
No
No
There currently are 1,774 burden hours approved in the OMB Inventory for 0915-0036. We are requesting approval for 1,165 hours, which is 609 hours less than the last submission. This decrease in the number of responses and total burden hours is a program adjustment, reflecting a predicted decrease in the number of responses per respondent since the last clearance request.

$15,288
No
No
No
No
No
Uncollected
Carla Haddad 301 443-0165 Carla.Haddad@hrsa.hhs.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/24/2011


© 2024 OMB.report | Privacy Policy