Form 270 Form 270 Title IV Reimbursement or Heightened Cash Monitoring 2 (

OMB# 1845-0089
Expiration Date:xx/xx/xxxx

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Request for Title IV Reimbursement
or Heightened Cash Monitoring 2 (HCM2)

Form 270
Any institution presently on or placed on the Reimbursement or Heightened Cash Monitoring (HCM2) funding
methods must now complete Form 270 and submit it with each claim when requesting reimbursement of Title IV
funds under the Reimbursement or HCM2 methods of payment. Please note that the institution can submit one
form for all Title IV programs request/authorization.
The following pages provide instructions for completing the Form 270. The format of the form has changed for
efficient and accurate entry and submission of information required for institutions to obtain Title IV
reimbursements.
Please read these instructions carefully. These instructions have been written in a general manner in order to be
used by all the various types of institutions that participate in the Title IV HEA student financial assistance
programs. Since different institutions use different methods for recording, processing or storing information, or
use different terminology for certain items, it is important to understand that it may be necessary to contact your
Payment Analyst for clarification before submitting a request in order to avoid discrepancies and delays.

Page 1 of 4
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-xxxx)
Prescribed by OMB Circulars A-102 &A-110

Completing The Request for Title IV Reimbursement
or Heightened Cash Monitoring 2 (HCM2) Form

OMB# 1845-0089
Expiration Date:xx/xx/xxxx

Print Form

INSTRUCTIONS
Follow the instructions provided, by item number, to accurately record the required entries.
ITEM #1 - METHOD OF PAYMENT TYPE:
Select HMC2 or Reimbursement.
ITEM #2 - INSTITUTION NAME AND ADDRESS:
Separated by commas, type the name of the institution, department/division, street address, maildrop/mailbox/suite (if applicable), city,
state, and zip code (e.g., Federal Student Aid College, Office of Financial Aid, 123456 American Street, Suite 7890,
Washington, DC 20202).
ITEM #3 - OPEID NUMBER:
Enter the institution's eight (8) digit OPEID#.
ITEM #4 - DUNS NUMBER:
Enter the institution's nine (9) digit DUNS number.
ITEM #5 - DEPARTMENT OF EDUCATION - FEDERAL STUDENT AID:
Using the drop down feature, select the Federal Student Aid School Participation Team (SPT) servicing the state for your institution.
ITEM #6 - COMPUTATIONS:
6A. - ESTIMATED FEDERAL CASH OUTLAYS TO BE MADE.
Enter the award year (e.g., "08/09") of the request as the time period for the total Title IV amount disbursed.
Enter the dollar amounts requested for each program (PELL, ACG, SMART, TEACH, FSEOG, FWS, DL and/or FFEL), using only
digits and a decimal to separate cents (e.g., 1234567.89).

Page 2 of 4
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-xxxx)
Prescribed by OMB Circulars A-102 &A-110

INSTRUCTIONS

OMB# 1845-0089
Expiration Date:xx/xx/xxxx

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(continued)

6B. - LESS ESTIMATED BALANCE OF FEDERAL CASH ON HAND.
Select the appropriate date using the calendar. This date will represent the estimated balance of federal cash on hand for each
program (PELL, ACG, SMART, TEACH, FSEOG, FWS, DL and/or FFEL). Enter the dollar amounts of the cash on hand using only digits
and a decimal to separate cents (e.g., 1234567.89).
6C. - REQUESTED FUNDING AMOUNT(S).
Select the beginning and ending periods using the calendars. These dates will represent the period of requested federal funds for each
program (PELL, ACG, SMART, TEACH, FSEOG, FWS, DL and/or FFEL). In order to obtain the correct amounts for each program,
subtract line 6B from line 6A. After performing the calculations, enter the required dollar amounts using only digits and a decimal to
separate cents (e.g., 1234567.89).

Page 3 of 4
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-xxxx)
Prescribed by OMB Circulars A-102 &A-110

INSTRUCTIONS

OMB# 1845-0089
Expiration Date:xx/xx/xxxx

Print Form

(continued)

CERTIFICATION
WARNING & CERTIFICATION STATEMENTS: Prior to certifying the Form 270, read the warning and certification thoroughly.
Failure on behalf of certifying officials to comply with the Department of Education's warning, as
prescribed under the United States Criminal Code, Title 18, Section 1001, and oath, attesting
full knowledge of providing false or misleading information, could subject officials to fines,
imprisonment (up to five years), and/or deny the institution's request for Title IV funds.
COMPTROLLER OR THIRD PARTY SERVICER: The party assigned the responsibility of Comptroller or Third Party Servicer must submit his/
her digital signature. If a digital signature is not used in the Comptroller or Third Party
Servicer Signature area, print the Department of Education's Request for Title IV
Reimbursement or Heightened Cash Monitoring 2 (HCM2) Form and manually sign
page two.
Select the Certification Date using the calendar. Type your Legal Name (e.g., "John H. Doe"
or "Jane M. Doe"). Enter the ten-digit phone number without symbols (e.g., enter
(222) 333-4444 as 222333444). Enter the institution's official e-mail address on record at
the Department of Education. After completing the certification sections, print the
Form 270 and manually sign page two. If a digital signature
is not used in the Comptroller or Third Party Servicer area, print your Legal Name - if the
name was not typed in this area. Retain a copy of this completed form for your records.
PRESIDENT, OWNER OR CEO: Use the same instructions for certification as the Comptroller or Third Party Servicer.
, Payment Analyst

Mail this completed form and required documents to:

U.S. Department of Education, Federal Student Aid
School Participation Team Address
Page 4 of 4
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-xxxx)
Prescribed by OMB Circulars A-102 &A-110

OMB# 1845-0089
Expiration Date:xx/xx/xxxx

Request for Title IV Reimbursement or
Heightened Cash Monitoring 2 (HCM2)
1. Method of Payment Type:

HCM2

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Reimbursement

2. Institution Name and Address:
3. OPEID #

4. DUNS #

5. Department of Education - Federal Student Aid

6. Computations:
A. During Award Year:
[Estimated Federal
Cash Outlays To
Be Made]

PELL
$

ACG
$

SMART
$

TEACH
$

FSEOG
$

FWS
$

DL
$

FFEL
$

FPerkins
$

B. As Of [Month (MM)/Day (DD)/Year (YY):
[ Less Estimated Balance of Federal Cash
On Hand]

PELL
$

ACG
$

SMART
$

TEACH
$

$

C. For Period From Month/Day/Year to Month/Day/Year:
[Requested Amount Line A Minus B]

PELL
$

ACG
$

FWS
$

DL
$

FFEL
$

FPerkins
$

to

SMART
$

FSEOG

TEACH
$

FSEOG
$

FWS
$

DL
$

FFEL
$

FPerkins
$

Form 1 of 2
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-xxxx)
Prescribed by OMB Circulars A-102 &A-110

Request for Title IV Reimbursement or
Heightened Cash Monitoring 2 (HCM2)

OMB# 1845-0089
Expiration Date:xx/xx/xxxx

Print Form

Reset Form

Institution Name and Address:
OPEID #

DUNS #

PAPERWORK BURDEN STATEMENT
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB
control number. Public reporting burden for this collection of information is estimated to average five (5) hours per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The
obligation to respond to this collection is required to obtain or retain benefit (Section 415 of the General Education Provisions Act, 20 USC 1216a-1, and by the
following program regulation: 34 C.F.R. § 668.162, Student Assistance General Provisions). Send comments regarding the burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC
20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1845-0089.

CERTIFICATION

Comptroller or Third Party Servicer & President/Owner/Chief Executive Officer
WARNING: Any person who knowingly provides false or misleading information on this certification will be subject to the following: a) $250,000 fine per individual, b) $500,000
fine (per organization), and/or c) imprisonment (up to five (5) years) under the provisions of the United States Criminal Code, Title 18, Section 1001.
CERTIFICATION: In accordance with the WARNING set out above I certify that, to the best of my knowledge and belief, all information in this document is accurate, all Title IV
refunds, including Federal Family Education Loan and Federal Direct Loan refunds, have been made as required by Federal regulations and have been returned to the
appropriate Title IV program account, all credit balances have been paid, as required by Federal regulations (disbursed to students or returned to the appropriate Title IV
account) and the institution has no Title IV funds available, or has reported all Title IV cash on hand on the appropriate Form 270 included with this submission. False
certifications may also result in denial of payment to the institution of the funds requested.

Comptroller or Third
Party Servicer Signature:

Certification
Date:

President, Owner or
CEO Signature:

Certification
Date:

Legal Name Typed
or Printed:

Phone:

Legal Name Typed
or Printed:

Phone:

E-Mail Address:

E-Mail Address.

Form 2 of 2
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-xxxx)
Prescribed by OMB Circulars A-102 &A-110