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Health Education Assistance Loan (heal) Program, Forms
HEALTH EDUCATION ASSISTANCE LOAN (HEAL) PROGRAM, FORMS
OMB: 0915-0034
IC ID: 110097
OMB.report
HHS/HSA
OMB 0915-0034
ICR 199403-0915-002
IC 110097
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0034 can be found here:
2012-07-31 - Revision of a currently approved collection
2009-08-03 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HEALTH EDUCATION ASSISTANCE LOAN (HEAL) PROGRAM, FORMS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HRSA 504,
No
No
Form
505, 507,
No
No
Form
508
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
17,305
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
33,703
0
0
0
0
33,703
Annual IC Time Burden (Hours)
4,368
0
0
0
0
4,368
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.