Employment Certification for Public Service Loan Forgiveness

Forms and Documents

Document Name	Status
Employment Certification for Public Service Loan Forgiveness Form	Modified
OMB 83C 120611 PSLF DOB.doc Justification for No Material/Nonsubstantive Change	2011-12-12
Att_30-Day Supporting Statement 08052011.docx Supporting Statement A	2011-08-08

IC Document Collections

IC ID	Document Title	Status
198201	Employment Certification for Public Service Loan Forgiveness Form	Modified

ICR Details

OMB Control No: 1845-0110	ICR Reference No: 201112-1845-002
Status: Historical Active	Previous ICR Reference No: 201106-1845-002
Agency/Subagency: ED/FSA	Agency Tracking No: 4764
Title: Employment Certification for Public Service Loan Forgiveness
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: 12/20/2011
	Date Received in OIRA: 12/12/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	11/30/2014	11/30/2014
Responses	2,073,643	0	2,073,643
Time Burden (Hours)	1,036,822	0	1,036,822
Cost Burden (Dollars)	0	0	0

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Abstract: This form serves as the means by which eligible borrowers in the William D. Ford Federal Direct Loan Program indicate eligible employment for the purpose of final forgiveness under the Public Service Loan Forgiveness Program. The Department and its Direct Loan Program servicers will use the information collected on the Employment Certification for Public Service Loan Forgiveness form to determine whether a borrower has worked for a qualified employer during the certification period and whether payments made against a borrower's outstanding Direct Loan balance were qualifying payments for the purpose of the Public Service Loan Forgiveness (PSLF) program.

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Authorizing Statute(s): US Code: 20 USC 1087(e)(m) Name of Law: Higher Education Act of 1965, as amended
   PL: Pub.L. 110 - 84 401 Name of Law: The College Cost Reduction and Access Act of 2007
   PL: Pub.L. 110 - 315 451(b)(1)-(2) Name of Law: The HIgher Education Opportunity Act of 2008
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 21337	04/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 50189	08/12/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Employment Certification for Public Service Loan Forgiveness	N/A	Employment Certification for Public Service Loan Forgiveness

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,073,643	2,073,643	0	0	0	0
Annual Time Burden (Hours)	1,036,822	1,036,822	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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:

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Annual Cost to Federal Government: $1,020,000

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

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/12/2011

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