# Agency Forms Undergoing Paperwork Reduction Act Review

> Briefs, arguments, decisions, and more.

URL: https://www.frixlaw.com/law-library/documents/fr%3A95-29810

## Record

- **Collection:** Federal Register
- **Document type:** Notice
- **Published:** December 7, 1995
- **Citation:** 60 FR 62870

## Text

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

Agency Forms Undergoing Paperwork Reduction Act Review

Periodically, the Health Resources and Services Administration
(HRSA) publishes abstracts of information collection requests under
review by the Office of Management and Budget, in compliance with the
Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35). To request a
copy of the clearance requests submitted to OMB for review, call the
HRSA Reports Clearance Office on (301)-443-1129.
The following request has been submitted to the Office of
Management and Budget for review under the Paperwork Reduction Act of
1995:
Health Education Assistance Loan (HEAL) Program Physician's
Certification of Borrower's Total and Permanent Disability Form--New--
This form, completed by the HEAL borrower, the borrower's physician,
and the holder of the loan, is used to certify that the HEAL borrower
meets the total and permanent disability provisions. The PHS will use
this form to obtain precise information about the disability claim
which includes the following: (1) The borrower's consent to release
medical records to the Department of Health and Human Services and to
the holder of the borrower's HEAL loans, (2) pertinent information
supplied by the certifying physician, (3) the physician's certification
that the borrower is unable to engage in any substantial gainful
activity because of a medically determinable impairment that is
expected to continue for a long and indefinite period of time or to
result in death, and (4) information from the lender on the unpaid
balance. Failure to submit the required documentation will result in a
disability claim not being honored.

----------------------------------------------------------------------------------------------------------------
Responses Average Total
Type of respondent Number of per burden per burden
respondents respondent response (hours)
----------------------------------------------------------------------------------------------------------------
Borrower.................................................... 42 1.0 0.08 3
Physician................................................... 42 1.0 2.75 116
Lender...................................................... 35 1.2 0.17 7
----------------------------------------------------------------------------------------------------------------
Estimated Total Annual Burden: 126 hours.

Written comments and recommendations concerning the proposed
information collection should be sent within 30 days of this notice to:
Allison Eydt, Human Resources and Housing Branch, Office of Management
and Budget, New Executive Office Building, Room 10235, Washington, D.C.
20503.

Dated: December 1, 1995.
J. Henry Montes,
Associate Administrator for Policy Coordination
[FR Doc. 95-29810 Filed 12-6-95; 8:45 am]
BILLING CODE 4160-15-P

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Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A95-29810. Public record. Not legal advice.