Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form - Form 513

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0127 can be found here:

Documents and Forms

Document Name Document Type
Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form - Form 513 Form
513 Form 1845-0127 HEAL form 513 Draft 2017-Revised.doc Form

Information Collection (IC) Details

IC Title:	Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form - Form 513	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 60.35

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	513 Form	1845-0127 HEAL form 513 Draft 2017-Revised.doc		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: Health Education Assistance Loan	FR Citation: 79 FR 36299

Number of Respondents: 13	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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,338	0	-1,447	5,785
Annual IC Time Burden (Hours)	737	0	-246	983
Annual IC Cost Burden (Dollars)	35	-11	0	46

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.