Application and Employment Certification for Public Service Loan Forgiveness

ICR 202205-1845-004

OMB: 1845-0110

Federal Form Document

Forms and Documents
ICR Details
1845-0110 202205-1845-004
Received in OIRA 202001-1845-007
Application and Employment Certification for Public Service Loan Forgiveness
No material or nonsubstantive change to a currently approved collection   No
Regular 05/09/2022
  Requested Previously Approved
08/31/2023 08/31/2023
801,261 801,261
400,631 400,631
0 0

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.

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

Not associated with rulemaking

  85 FR 5405 01/30/2020
85 FR 20992 04/15/2020

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

  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
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.

Beth Grebeldinger 202 708-8242


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:
    (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;
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.

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