[Federal Register Volume 60, Number 235 (Thursday, December 7, 1995)]
[Notices]
[Page 62870]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-29810]



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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.

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