Application and Employment Certification for Public Service Loan Forgiveness

Forms and Documents

Document Name	Status
Application and Employment Certification for Public Service Loan Forgiveness Form Form and Instruction	Modified
1845-0110 Signed 83C Request 2022.pdf Justification for No Material/Nonsubstantive Change	2022-05-09
FedLoan Servicing Comments - Appl and Empl Cert for PSLF 5.14.2020 FSA response 20200811.docx Supplementary Document	2020-08-11
PSLFFormComments.docx Supplementary Document	2020-04-10
1845-0110 Supporting Statement post 30D OMB 7.2020 FSA response 20200811 no comments.docx Supporting Statement A	2020-08-11

IC Document Collections

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

ICR Details

OMB Control No: 1845-0110	ICR Reference No: 202205-1845-004
Status: Received in OIRA	Previous ICR Reference No: 202001-1845-007
Agency/Subagency: ED/FSA	Agency Tracking No:
Title: Application and 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	Date Submitted to OIRA: 05/09/2022

	Requested	Previously Approved
Expiration Date	08/31/2023	08/31/2023
Responses	801,261	801,261
Time Burden (Hours)	400,631	400,631
Cost Burden (Dollars)	0	0

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Abstract: The Department is requesting a Simple Change to the Public Service Loan Forgiveness (PSLF) & Temporary Expanded PLSF (TEPSLF) Certification and Application. This change to the form is needed as the federal student loan servicer for the PSLF and TEPSLF form is changing from FedLoan Servicing to MOHELA and contact information needs to be updated on the form in preparation of the transfer. There is no change anticipated in the number of respondents/responses/burden hours that have been approved through OMB previously.

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Authorizing Statute(s): US Code: 20 USC 1087(e)(m) Name of Law: Higher Education Act of 1965, as amended
  

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:
	85 FR 5405	01/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 20992	04/15/2020
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
Application and Employment Certification for Public Service Loan Forgiveness Form	N/A	N/A

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ICR Summary of Burden

	Total Request	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	801,261	801,261	0	0	0	0
Annual Time Burden (Hours)	400,631	400,631	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: This is a program change of the revision that represents an increase of 36,421 burden hours due to the result of a new combined form for borrowers to submit for employment considerations and to have TEPSLF eligibility.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 05/09/2022

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