Application and Employment Certification for Public Service Loan Forgiveness Form

Application and Employment Certification for Public Service Loan Forgiveness

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0110 can be found here:

Documents and Forms

Document Name Document Type
Application and Employment Certification for Public Service Loan Forgiveness Form Form and Instruction
1845-0110_PSLF.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Application and Employment Certification for Public Service Loan Forgiveness Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	N/A	N/A	1845-0110_PSLF.pdf		Yes	No	Printable Only

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: Common Services for Borrowers	FR Citation: 79 FR 117

Number of Respondents: 801,261	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	801,261	72,842	728,419
Annual IC Time Burden (Hours)	400,631	36,421	364,210
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.