Form 270 Form 270 Title IV Reimbursement for Heightened Cash Monitoring

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

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-2015)

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

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

INSTRUCTIONS
Follow the instructions provided, by item number, to accurately record the required entries.
ITEM #1 - METHOD OF PAYMENT TYPE:
Select HCM2 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 Division (SPD)
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,
TEACH, FSEOG, FWS, and/or DL), using only digits and a decimal to separate cents
(e.g., 1234567.89).

Page 2 of 4
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-2015)

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

INSTRUCTIONS
(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, TEACH, FSEOG, FWS, and/or DL). 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, TEACH, FSEOG, FWS, and/or
DL). 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-2015)

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

INSTRUCTIONS
(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 Division - Select a School Participation Division
Address

Select the School Participation Division Address

Page 4 of 4
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-2015)

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

Reimbursement

2. Institution Name and Address:
3. OPEID #

4. DUNS #

4. Department of Education- Federal Student Aid

Select the School Participation Division Address

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

PELL

TEACH

FSEOG

FWS

DL

FPerkins

FSEOG

FWS

DL

FPerkins

FWS

DL

FPerkins

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

PELL

TEACH

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

to
PELL

TEACH

FSEOG

FORM 1 of 2
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-2015)

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

Request for Title IV Reimbursement or
Form 1 of 2
Heightened Cash Monitoring 2 (HCM2)
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. The valid
OMB control number for this information collection is 1845-0089. Public reporting burden for this collection of information is estimated to average 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 a 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). If you have comments or concerns regarding the status of your individual submission of this form, please contact the appropriate School Participation
Division using the contact information on page 4 of this form.

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 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:

Comptroller or Third
Party Servicer Signature:

Certification Date:

Legal Name Typed
or Printed:

Phone:

Legal Name Typed
or Printed:

Phone:

Email Address:

Email Address:

Form 2 of 2
AUTHORIZED FOR LOCAL REPRODUCTION

FORM 270 (xx-2015)