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OMB Control No: 1845-0127	ICR Reference No: 201406-1845-018
Status: Historical Active	Previous ICR Reference No: 201406-1845-004
Agency/Subagency: ED/FSA	Agency Tracking No: 2040
Title: Health Education Assistance Loan (HEAL) Program: Lender's Application for Insurance Claim Form and Request for Collection Assistance Form
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/25/2014
	Date Received in OIRA: 06/24/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	10/31/2014	10/31/2014
Responses	6,149	0	6,149
Time Burden (Hours)	1,165	0	1,165
Cost Burden (Dollars)	2,594	0	2,594

Abstract: 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. Section 525 of the Consolidated Appropriations Act, 2014 transferred the collection of the Health Education Assistance Loan (HEAL) program loans from the US Department of Health and Human Services (HHS) to the US Department of Education (ED). To fulfill this mandate, ED requested and received the transfer of the currently approved forms to a new collection under Federal Student Aid OMB Control Number prefix 1845. The changes to the approved forms will be to identify ED as the agency owner of the HEAL loans, identify new contact information, and minor spelling corrections.

Authorizing Statute(s): 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

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 30948	05/27/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 51042	08/17/2011
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	6,149	6,149
Annual Time Burden (Hours)	1,165	1,165
Annual Cost Burden (Dollars)	2,594	2,594

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $15,288

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Beth Grebeldinger 202 708-8242

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