Third Party Partner Connect

Partner Participation Oversight Third Party Servicer Inquiry Form

Third-Party Servicer Inquiry Form

Confirmation

Text

Field Type

A third-party servicer is an entity or individual that administers any aspect of an institution’s participation in the Title IV programs, including, but not limited to, services and functions necessary: For the institution to remain eligible to participate in the Title IV programs, To determine a student’s eligibility for Title IV funds, To account for Title IV funds, To deliver Title IV funds to students, or To perform any other aspect of the administration of the Title IV programs. In making a determination as to whether or not an entity or individual is considered a third-party servicer, the Department looks at each case individually and focuses on the specific service(s) or function(s) being performed at that institution, as opposed to a title that the entity may be using or a generic description of the types of services provided. Servicers often offer multiple versions of a product or service and frequently customize a product or service based on an institution’s unique needs. It is possible for an entity to be considered a third-party servicer at one institution and not at another depending on the specific services or functions that the entity performs at each institution. Submission of this inquiry and any supporting documentation is required if you contract with an institution to perform functions or services related to an institution’s Title IV eligibility, the eligibility of the institution’s academic programs, or a student’s Title IV eligibility.

Display Only

General Information

Number	Text	Field Type
	For purposes of this form, company/organization refers to an individual or a state agency, or a private, profit, or non-profit organization that enters into a contract or agreement with an eligible institution to administer any aspect of the institution’s participation in the Title IV programs.	Display Only
1	What is the purpose of this inquiry? <help text icon>  <Help Text>  Select Initial Inquiry if this is the first time a TPS inquiry is being submitted for this company/organization.    Select Merger/Acquisition if this company/organization purchased another third-party servicer that is becoming a part of this company/organization.    Select Withdrawal/Closure if this company/organization is being purchased by another third-party servicer or if this entity is ceasing to perform functions and services on behalf of Title IV eligible institutions.    Select Update Information to update information previously reported.	Picklist Initial Inquiry, Merger/Acquisition, Withdrawal/Closure, Update Information
2.	What is the legal name of this Company/Organization? <help text icon>    Help Text: Please provide the legal name of this company/organization.  You will provide trade names, d/b/a names, and ownership names in the demographic and ownership sections.	Text
3.	What is the EIN/TIN of this company/organization? <help text icon>    <Help Text>  The 9-digit identification number that the U.S. Internal Revenue Service (IRS) assigned to you for federal tax reporting purposes.  If your EIN/TIN has changed, please provide an explanation in the additional comment box below.	Number
	Additional Comment	Text
4.	What is the Unique Entity Identifier (UEI) of this company/organization? <help text icon>  <Help Text>  The 12-digit unique alpha-numeric entity identifier assigned to you by the GSA. To request your UEI and register your servicer, please visit www.SAM.gov.	Number
5.	Identify the specific functions or services that this Company/Organization performs on behalf of Title IV eligible institutions. <help text icon>  Help Text: Select all of the main and specific service(s) that apply. If you do not see a service in the list provided, select “Other” and provide an explanation of the functions or service(s) performed.	Text
	Main Service Provided	Picklist
	Specific Service Provided	Conditional Picklist
	Other: Please describe the services provided.	Text
6.	When did this company/organization begin conducting business as a third-party servicer on behalf of Title IV, HEA institution(s)? <help text icon> <help text> Provide the date this company/organization began providing the functions or services identified on this inquiry to institutions of higher education.	Date
7.	Please indicate the Department systems that this company/organization accesses or utilizes to perform functions on behalf of eligible higher education institutions.	Multi-Select Picklist School Eligibility Application (E-APP), Common Origination and Disbursement System (COD), National Student Loan Data System (NSLDS), Central Processing System (CPS), Integrated Postsecondary Education Data System (IPEDS), G5, Partner Connect, Other
8.	Does this company/organization download or receive files containing information downloaded from Department systems to perform functions on behalf of eligible higher education institutions? <help text icon>    Help Text:  Select yes, if this company/organization has direct access to download information from Department systems and/or receives files downloaded from Department systems from institutions of higher education or other entities.	Picklist (Yes/No)
9.	Does this company/organization have access to information downloaded from Department systems into an eligible higher education institution’s system or another entity’s system?  <help text icon>    Help Text:  Select yes, if this company/organization has access to institutional systems or another entity’s system that contain student information downloaded from CPS, COD, NSLDS, or other Department systems.	Picklist (Yes/No)
10.	How does this company/organization maintain data it downloads from Department systems and/or received from institutions of higher education or other entities?	Picklist Internal software system owned or created by this company/organization, System owned by another company/organization, No data is downloaded or maintained by this company/organization
11.	Provide the name of the software system utilized, the name of the company that provides the software system, as well as the address, Telephone number, website, and start/end date for the software provider(s). <help text icon> <Help text> Provide information for all software systems this company/organization utilizes to perform functions or services on behalf of higher education institutions.	Display Only
	Name of Software System	Text
	Name of Software Company	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/ Territory	Text
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Telephone Number	Number
	Ext.	Number
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	Website	Text
12.	Effective date <help text icon> <help text> Enter the date this company/organization began utilizing this software system.	Date
13.	End date <help text icon> <help text> Enter the date this company/organization stopped utilizing this software system.	Date
14.	Is this software system maintained on servers owned and controlled by this company/organization, institutions of higher education, or the software service provider?	Picklist Company/Organization, Institution of Higher Education, Software Provider
15.	Is this system maintained in a cloud environment?	Picklist (Yes/No)

Demographic Information

Number	Text	Field Type
1.	Does this company/organization have another name such as a trade name or a d/b/a name, under which the company conducts business? <help text icon>  Help text:  Please enter all trade names or d/b/a names. The name(s) typed here should not be the same name that you entered as your Legal Name.	Picklist (Yes/No)
	Trade or D/B/A Name	Text
2.	Has this company ever operated under different name(s)? If yes, please provide the name(s):	Picklist (Yes/No)
	Former Company/Organization Name	Text
3.	What name does this company/organization utilize to file its required annual compliance audit?	Text
4.	What is the fiscal year end date for this company/organization?	Date
5.	What is the URL for this company/organization’s website? <help text icon> <Help Text> Type in the address of your website. EXAMPLE: www.thirdpartyservicer.com	Website URL

Contact Information

Number	Text	Field Type
1	Who is the Eligibility & Oversight Administrator for this company/organization? <Help Text icon>  <help text>    Eligibility and Oversight Administrators create users and grant access to Partner Connect features on behalf of the institution or company/organization they work for.	Display Only
	Prefix	Text
	First Name  <help text icon>      Help Text:    You must provide the full legal name of this individual.	Text
	Middle Name  <help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	E-mail Address	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2
	City	Text
	State/ Territory	Text
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Telephone Number	Number
	Ext.	Number
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	Effective Date	Date
	End Date	Date
2	Who is the Alternate Eligibility & Oversight Administrator for your organization?	Display Only
	Prefix	Text
	First Name  <help text icon>      Help Text:    You must provide the full legal name of this individual.	Text
	Middle Name  <help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	E-Mail Address	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/ Territory	Text
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Telephone Number	Number
	Ext.	Number
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	E-Mail Address	Text
	Effective Date	Date
	End Date	Date
3	Who is completing this form?	Display Only
	If this person is the same as one of the individuals entered in a previous question or a previous inquiry, select the person from the list provided. If this is a new person, please provide the information requested below.	Checkbox
	Select individual	Picklist  Eligibility & Oversight Administrator  Alternate Eligibility & Oversight Administrator  Highest Ranking Officer Primary Contact Secondary Contact
	Prefix	Text
	First Name  <help text icon>      Help Text:    You must provide the full legal name of this individual.	Text
	Middle Name  <help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	E-Mail Address	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/Territory	Picklist
	Foreign Province	Text
	Zip	Number
	+4	Number
	Postal Code	Text
	Telephone Number	Number
	Ext	Number
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
4	Who is the highest-ranking officer (CEO/COO/President) of this company/organization?	Display Only
	If this person is the same as one of the individuals entered in a previous question or a previous inquiry, select the person from the list provided. If this is a new person, please provide the information requested below.	Checkbox
	Select individual	Picklist  Eligibility & Oversight Administrator   Alternate Eligibility & Oversight Administrator  Individual completing this form  Primary Contact Secondary Contact
	Prefix	Text
	First Name   <help text icon>      Help Text:    You must provide the full legal name of this individual.	Text
	Middle Name  <help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	E-Mail Address	Text
	Please provide the Home Address of the highest-ranking officer.	Text
	Home Address 1	Text
	Home Address 2	Text
	City	Text
	State	Text
	Zip	Number
	Personal Telephone Number	Number
	Fax Number	Number
	Personal E-Mail Address	Text
	Effective Date	Date
	End Date	Date
5.	Please provide the name and home address of the primary and secondary contacts of this company/organization.	Display Only
	If this person is the same as one of the individuals entered in a previous question or a previous inquiry, select the person from the list provided. If this is a new person, please provide the information requested below. <help text icon> <Add Help Text> The primary and secondary contacts cannot be the same person as the highest ranking official.	Checkbox
	Select individual	Picklist  Eligibility & Oversight Administrator  Alternate Eligibility & Oversight Administrator  Individual completing this form
	Primary	Checkbox
	Secondary	Checkbox
	Prefix	Text
	First Name   <help text icon>      Help Text:    You must provide the full legal name of this individual	Text
	Middle Name<help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	E-Mail Address	Text
	Personal E-Mail Address	Text
	Home Address 1	Text
	Home Address 2	Text
	City	Text
	State	Text
	Zip	Number
	Personal Telephone Number	Number
	Fax Number	Number
	Effective Date	Date
	End Date	Date

Servicer Structure Information

	Text	Field Type
1.	What is the IRS Designation of this company/organization?	Picklist Public Private Non-Profit Proprietary
2.	Select the ownership type for this company/organization.	Picklist: Corporation (Publicly-traded) Corporation (closely held under provisions of state law) Corporation (for profit, not publicly-traded or closely held under provisions of state law) Corporation (for profit - Certified B) Corporation (nonprofit) Corporation (public benefit) Limited liability company (for profit) Limited liability company (nonprofit) Limited liability partnership (for profit) Limited liability partnership (nonprofit) Limited liability limited partnership (for profit) Limited liability limited partnership (nonprofit) General partnership (for profit) General partnership (nonprofit) Sole proprietorship  Trust (Irrevocable) Trust (Irrevocable nonprofit) Trust (Revocable) Foreign Entity Other
3.	Identify the country in which this company/organization is incorporated/organized.	Picklist
	Identify the state in which this company/organization is incorporated:	Picklist (if country = USA)
4.	If you selected Publicly Traded Corporation above, provide the stock exchange trading symbol	Text
5.	Provide the name and business address of the authorized representative within the state or foreign country where this company/organization is incorporated.	Text
	Prefix	Text
	First Name   <help text icon>      Help Text:    You must provide the full legal name of this individual	Text
	Middle Name<help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	E-Mail Address	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/ Territory	Text
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Telephone Number	Number
	Ext	Number
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	Upload a copy of the company's organizational chart with employee names and titles.	Document Upload
6.	Does this company/organization own an eligible or ineligible institution of higher education or entity that provides postsecondary educational programs?	Picklist (Yes/No)
	Provide the OPEID of each institution that is owned.	OPEID Search
	If the institution cannot be found in the search, provide the name of the institution or entity that is owned.	If OPEID selected, populates with data of OPEID selected
	Institution or Entity Name	Text
	Percentage of Ownership	Percentage
	Ownership Effective Date:	Date
	Ownership End Date:	Date
7.	Does this company/organization own any percentage of another company/organization that administers any aspect of an institution's participation in the Title IV programs?	Picklist (Yes/No)
	Provide the name of the Third-Party Servicer or other company/organization that is owned.	TPS Search
	If the Third-Party Servicer or company/organization could not be found, provide the name of the Third-Party Servicer or company/organization that is owned.	Text
	Percentage of Ownership	Number
	Provide the following information for the primary contact at the third-party servicer or company/organization that is owned.	Text
	Job Title	Text
	Prefix	Text
	First Name   <help text icon>      Help Text:    You must provide the full legal name of this individual	Text
	Middle Name<help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	E-Mail Address	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/Territory	Picklist
	Zip Code	Number
	+4	Number
	Foreign Province	Text
	Postal Code	Number
	Telephone	Number
	Ext.	Number
	Fax	Number
	Ext.	Number
	International Phone	Number
	Ext	Number
	International Fax	Number
	Ext	Number
	TPS Owned Effective Date:	Date
	TPS Owned End Date:	Date

Ownership Information

	Text	Field Type
	Provide information for each entity or individual that owns an interest in this company/organization regardless of percentage.	Display Only
1.	Type of Owner	Picklist (Entity Owner/Person Owner)
	Percentage of Ownership	Percentage
	Ownership Effective Date	Date
	Ownership End Date:	Date
	Provide the Legal Name of this Entity Owner	Text
	Provide the contact information for this owner. <Help Text Icon> <Help Text> Provide the Full Legal Name, Business Address, Telephone, Fax Number and E-mail Address for this owner.	Display Only if Person Owner
	Provide the Full Legal Name, Business Address, Telephone, Fax Number and E-mail Address for the Primary Contact of this owner.	Display only if Entity Owner
	If this person is the same as one of the individuals entered in a previous question or previous inquiry, select the person from the list provided. If this is a new person, please provide the information requested below.	Picklist
	Job Title	Text
	Prefix	Text
	First Name   <help text icon>      Help Text:    You must provide the full legal name of this individual	Text
	Middle Name<help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	Country	Text
	Business Address 1	Text
	Business Address 2	Text
	Suite/Apt	Text
	City	Text
	State/Territory	Text
	Zip	Text
	+4	Text
	Postal Code	Text
	Foreign Province	Text
	Telephone Number	Text
	Fax Number	Text
	International Telephone	Number
	Ext	Number
	International Fax	Number
	Fax Ext	Number
	E-Mail Address	Text
2.	Identify the IRS Designation of this Entity Owner:	Picklist Public Private Non-Profit Proprietary
3.	Select the ownership type for this company/organization from the choices below (select only one).	Picklist: Corporation (Publicly-traded) Corporation (closely held under provisions of state law) Corporation (for profit, not publicly-traded or closely held under provisions of state law) Corporation (for profit - Certified B) Corporation (nonprofit) Corporation (public benefit) Limited liability company (for profit) Limited liability company (nonprofit) Limited liability partnership (for profit) Limited liability partnership (nonprofit) Limited liability limited partnership (for profit) Limited liability limited partnership (nonprofit) General partnership (for profit) General partnership (nonprofit) Sole proprietorship  Trust (Irrevocable) Trust (Irrevocable nonprofit) Trust (Revocable) Foreign Entity Other
4.	Identify the country in which this company/organization is incorporated/organized.	Picklist
5.	Identify the state in which this company/organization is incorporated:	Picklist
6.	If the ownership type for this owner is Publicly Traded Corporation, provide the stock exchange trading symbol	Text
7.	Provide the name and business address of the authorized representative within the state where this owner is incorporated.	Text
	Prefix	Text
	First Name   <help text icon>      Help Text:    You must provide the full legal name of this individual	Text
	Middle Name<help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	E-Mail Address	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2
	City	Text
	State/ Territory	Text
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Telephone Number	Number
	Ext
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	Please provide a copy of the company's organizational chart with employee names and titles.	Document Upload
	Comment	Text
8.	Does this owner own an eligible or ineligible institution of higher education or entity that provides postsecondary educational programs?	Picklist (Yes/No)
	Provide the OPEID of each institution that is owned.	OPEID Search
	If the institution cannot be found in the search, provide the name of each institution that is owned.	Populates with data of OPEID entered
	Institution or Entity Name	Text
	Percentage of Ownership	Percentage
	Institution Owned Effective Date:	Date
	Institution Owned End Date:	Date
	Provide the name of the Third-Party Servicer or other company/organization that is owned.	TPS Search
	If the Third-Party Servicer or company/organization could not be found, provide the name of the Third-Party Servicer or company/organization that is owned.	Text
	Percentage of Ownership
	Please provide the full legal name, business address, Telephone, fax number, and E-mail of the primary contact for the Third-Party Servicer or company/organization that is owned.	Text
	Prefix	Text
	First Name   <help text icon>      Help Text:    You must provide the full legal name of this individual	Text
	Middle Name<help text icon>      Help Text:    If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	E-Mail Address	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/Territory	Picklist
	Zip Code	Number
	Foreign Province	Text
	Postal Code	Number
	Telephone	Number
	Ext.	Number
	Fax	Number
	Ext.	Number
	International Phone	Number
	Ext	Number
	International Fax	Number
	Fax Ext	Number
	TPS Owned Effective Date:	Date
	TPS Owned End Date:	Date

Location Information

	Text	Field Type
1	Provide the primary address of this company/organization.	Display
	Country	Picklist
	Business Address 1	Text
	Business Address 2
	City	Text
	State/ Territory	Picklist
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
2	Check here if the mailing address for this company/organization is the same as the business address	Checkbox
	Country	Picklist
	Mailing Address 1	Text
	Mailing Address 2	Text
	City	Text
	State/ Territory	Picklist
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
3	Check here if this company/organization has additional locations (processing center, etc.)	Checkbox
	Provide the purpose, address, Telephone number and primary contact for each location	Text
	Location Purpose	Picklist
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/ Territory	Picklist
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	End Date	Date
	Primary Contact	Display Only
	Prefix	Text
	First Name  <help text icon>    Help Text:   You must provide the full legal name of this individual	Text
	Middle Name<help text icon>    Help Text:   If this individual does not have a middle name, enter NMN	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	Primary Contact Address	Display Only
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/ Territory	Picklist
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Telephone Number	Number
	Ext	Number
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	E-mail Address	Text
	Identify the specific functions or services that this company/organization performs at this location. <Help Text Icon> Help Text: Select all of the main and specific service(s) that apply. If you do not see a service in the list provided, select “Other” and provide an explanation of the functions or service(s) performed.	Display Only
	Main Service Provided	Picklist
	Specific Service Provided	Conditional Picklist
	Other: Please describe the services provided.	Text
	Effective Date	Date
	End Date	Date

Client Information

	Text	Field Type
	Provide information for each institution of higher education this company/organization contracts with to administer any aspect of the Title IV, HEA programs.	Display Only
1.	Select the institution(s) that contract with this company/organization.	School Search
	OPEID	Number
	Partner Connect ID	Number
	School Name	Text
	If the institution cannot be found in the search, provide the name of the Institution	Text
	Provide the services performed for this client	Display
	Select all of the main and specific service(s) that apply. If you do not see a service in the list provided, select “Other” and provide an explanation of the functions or service(s) performed?	Display
	Main Service Provided	Picklist
	Specific Service Provided	Conditional Picklist
	Other: Please describe the services provided.	Text
2.	Indicate the Department system(s) that this company/organization accesses or utilizes to perform functions on behalf of this institution.	Multi-Select Picklist School Eligibility Application (E-APP), Common Origination and Disbursement System (COD), National Student Loan Data System (NSLDS), Central Processing System (CPS), Integrated Postsecondary Education Data System (IPEDS), G5, Partner Connect Other
3.	Does this company/organization download or receive files containing information downloaded from Department systems to perform functions on behalf of this eligible higher education institution?	Picklist (Yes/No)
4.	Does this company/organization have access to information downloaded from Department systems into an eligible higher education institution’s system?	Picklist (Yes/No)
5.	Contract Effective Date	Date
6.	Contract End Date	Date
7.	Submit a copy of the company/organization’s contract with this institution.	Document Upload

Subcontractors and Affiliates Information

	Text	Field Type
1.	Does this company/organization outsource or subcontract any of the services it performs on behalf of an eligible institution to another company/organization or individual?	Picklist (Yes/No)
2.	Provide the legal name of the company/organization or individual that this company/organization subcontracts with.	Text
3.	Provide the trade name or d/b/a of the company/organization that this company/organization subcontracts with.	Text
4.	Provide the name of the owner(s) of the company/organization that this company/organization subcontracts with.	Display Only
	Prefix	Text
	First Name	Text
	Middle Name	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/ Territory	Picklist
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Country	Picklist
	Telephone Number	Number
	Ext	Number
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	E-Mail Address	Text
	Website	URL
5.	When did the company/organization begin subcontracting services to this company/organization or individual?	Date
6.	Identify the functions or services performed by this subcontractor.	Display
	Select all of the primary and specific service(s) that apply. If you do not see a service in the list provided, select “Other” and provide an explanation of the functions or service(s) performed?	Display
	Main Service Provided	Picklist
	Specific Service Provided	Conditional Picklist
	Other: Please describe the services provided.	Text
	Subcontractor Service Effective Date	Date
	Subcontractor Service End Date	Date
7.	Please indicate the Department systems that this subcontractor accesses or utilizes to perform functions on behalf of this company/organization or the institutions of higher education included in the scope of the contract.	Picklist
8.	Does this subcontractor download or receive files containing information downloaded from Department systems to perform functions on behalf of this company/organization or the institutions of higher education included in the scope of the contract?	Picklist (Yes/No)
9.	Does this subcontractor have access to information downloaded from Department systems into an eligible higher education institution’s system?	Picklist (Yes/No)
	Submit a copy of the company/ organization’s contract with this subcontractor.	Document Upload
10.	Provide the effective date of the contract with this subcontractor.	Date
11.	Provide the end date of the contract with this subcontractor	Date

Merger/Acquisition Information:

Number	Text	Field Type
1.	You selected merger/acquisition as the purpose of this inquiry. Please provide a detailed written description of the merger/acquisition that you are reporting and upload documentation that supports this transaction. <Help Text Icon> <Help Text> Identify the companies/organizations that are included in this transaction, the effective date of the transaction, the impact this transaction has on locations, employees, access to Department systems, institutional contracts, etc. in the written description provided.  Update all applicable sections of this inquiry to reflect the changes that need to be made as a result of this merger/acquisition.	Narrative Box and ability to upload documents

Withdrawal Inquiry:

	Text	Field Type
1.	You selected TPS Withdrawal/Closure as the purpose of this inquiry. Please provide the actual or anticipated withdrawal/closure date of this company/organization.	Date
2.	What is the reason for your withdrawal from Title IV? <help text icon> <help text> Select No Longer Providing Title IV Services if this company/organization is closing or will no longer provide Title IV related services to instituitons of higher education. Select Merger/Acquisition if an existing Third-Party Servicer is purchasing this company/organization. Select Change in Ownership if the individual or company/organization that is purchasing this company/organization is not an existing Third-Party Servicer.	Picklist No Longer Providing Title IV Services, Merger/Acquisition, Change In Ownership, Other
3.	You selected Merger/Acquisition as the reason for withdrawal. Provide the TPS ID of the Third-Party Servicer that is purchasing this company/organization.	Search
	If the organization cannot be found in the search, provide the name of the Third-Party Servicer or company/organization that is purchasing this company/organization	Required if no organization was selected in search
	Partner Connect ID	Number
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/ Territory	Picklist
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Country	Picklist
	Effective Date of Merger/Acquisition:	Date
3.	You selected Change in Ownership as the reason for withdrawal.
	Provide the contact information for the new owner of this company/organization.	Display
	Prefix	Text
	First Name	Text
	Middle Name	Text
	Last Name	Text
	Suffix	Text
	Job Title	Text
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/Territory	Picklist
	Foreign Province	Text
	Zip Code	Text
	+4	Text
	Postal Code	Text
	Telephone Number	Number
	Ext
	International Telephone Number	Number
	Ext	Number
	Fax Number	Number
	Ext.	Number
	International Fax Number	Number
	Ext.	Number
	E-mail Address	Text
4.	Please provide a detailed written description of the merger/acquisition or Change in Ownership that you are reporting for this company/organization. <help text icon> <Help Text> Please identify the: Companies/organizations that are included in this transaction, Impact this transaction has on this company/organization’s locations, employees, contracts with higher education institutions, information stored in software systems, employee access to Department systems, etc. in the written description provided.  Please upload documentation to support this transaction.	Narrative Box and Ability to Upload Documents

Upload Documents

	Text	Field Type
	You must upload the documents listed below in order to successfully submit your inquiry. To provide a new document, select "Upload New." Use the Upload Other Documents button to provide any additional documents you would like to provide in support of this inquiry. The documents you have uploaded will then be displayed in the list below. Please be sure to encrypt any documents containing Personally Identifiable Information (PII) data. If you are unable to encrypt PII data, please contact the Third-Party Servicer Oversight Group.	Display
	Document Upload Component	File Uploader
	Does this document contain PII data?	Picklist (Yes, No)
	Document Type
	Check here if you will be providing the URL to where this document type is located on your institution’s Web site in the document description below.	Checkbox
	Enter a description of the document	Text

Submit TPS Inquiry Form

	Text	Field Type
	Who is the authorized signature authority for this company/organization? <help text icon> <help text) This individual(s) is authorized to execute contracts, financial documents, and other official documents on behalf of this company/organization.	Display Only
	Check here if this is the same person as your: Highest Ranking Officer (CEO/COO/President)	Checkbox
	Select position.	Picklist Highest Ranking Officer, Primary Contact
	Check here if it is the same person as a Person Owner reported for the company/organization.	Checkbox
	Select Owner	Picklist of Person Owners
	Job Title	Text
	Prefix	Text
	First Name	Text
	Middle Name	Text
	Last Name	Text
	Suffix	Text
	E-mail Address	E-mail Address
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/Territory	Picklist
	Foreign Province	Text
	Zip Code	Number (XXXXX)
	+ 4	Number (XXXX)
	Postal Code	Alpha-Numeric
	Telephone	Number
	International Telephone	Number
	Ext	Number
	Fax	Number
	International Fax Number	Number
	Ext	Number
	Provide the Home Address, Telephone Number, and E-mail Address for this authorized signature authority.	N/A
	Country	Picklist
	Home Address 1	Text
	Home Address 2	Text
	City	Text
	State/Territory	Picklist
	Foreign Province	Picklist
	Zip Code	Number (XXXXX)
	+ 4	Number (XXXX)
	Postal Code	Alpha-Numeric
	Personal E-mail Address	E-mail
	Personal Telephone Number (include Area Code)	Number
	Effective Date	Date
	End Date	Date
	Please check here, if your authorized signature authority is not available to sign this application.	Checkbox
	Explain
	Add contact information for the delegated authority who may sign on behalf of the authorized signature authority. <help text icon> <help text> This individual has been delegated the authority to execute contracts, financial documents, and other official documents in the absence of the authorized signature authority. You must upload a signed statement on company letter head that describes the time period, and the terms and conditions of the authority granted each time a delegation occurs.
	Job Title	Text
	Prefix	Text
	First Name	Text
	Middle Name	Text
	Last Name	Text
	Suffix	Text
	E-mail Address	E-mail Address
	Country	Picklist
	Business Address 1	Text
	Business Address 2	Text
	City	Text
	State/Territory	Picklist
	Foreign Province	Text
	Zip Code	Number (XXXXX)
	+ 4	Number (XXXX)
	Postal Code	Alpha-Numeric
	Telephone Number	Number
	Ext	Number
	International Telephone Number	Number
	Ext	Number
	Fax	Number
	International Fax Number	Number
	Ext	Number
	Provide the Home Address, Telephone Number, and E-mail Address for this delegated authority.	N/A
	Country	Picklist
	Home Address 1	Text
	Home Address 2	Text
	City	Text
	State/Territory	Picklist
	Foreign Province	Text
	Zip Code	Number (XXXXX)
	+ 4	Number (XXXX)
	Postal Code	Alpha-Numeric
	Personal E-mail Address	E-mail
	Personal Telephone Number	Number
	Effective Date	Date
	End Date	Date

Certification Statement

Text	Field Type
I hereby certify that, to the best of my knowledge, and belief, all information in this document is true and correct. I understand that if my company/organization provides false or misleading information, the U.S. Department of Education considers this to be a breach of the fiduciary standard of conduct and may terminate the servicer’s eligibility to contract with any institution to administer any aspect of an institution’s participation in the Title IV, HEA programs. I also understand that providing false or misleading information on this form is a violation of the United States Criminal Code, Title 18, Section 1001 and may result in a fine of up to $250,000 for an individual or $500,000 for an organization, and/or imprisonment for up to five years, or both, for misinformation that is material to receipt and stewardship of federal student financial aid funds.	Text and Check Box
I agree to comply with all statutory provisions applicable to Title IV of the HEA, all regulatory provisions prescribed under that statutory authority, and all special arrangements, agreements, limitations, suspensions, and terminations entered into under the authority of Title IV of the HEA.	Text and Checkbox
I also agree to refer to the Office of Inspector General of the U.S. Department of Education for investigation any information indicating there is reasonable cause to believe that the institution might have engaged in fraud or other criminal misconduct in connection with the institution's administration of any Title IV, HEA program or an applicant for Title IV, HEA program assistance might have engaged in fraud or other criminal misconduct in connection with his or her application.	Text and Check Box
I understand that access to information in Department systems may only be used for the Title IV function or service that is being performed. The data contained in Department systems such as the National Student Loan Data System (NSLDS), the Common Origination and Disbursement (COD) System, or the Central Processing System (CPS) are confidential and are protected by the Privacy Act of 1974, as amended, and other applicable statutes, and regulations. Failure to comply with Department access and user requirements may result in the organization or individual losing access to Department systems and/or being subject to sanctions, including, but not limited to, the initiation of a limitation, suspension, or termination action or a debarment proceeding against the individual, the institution, and/or third-party servicer.	Text and Check Box