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

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

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

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.

Mail this completed form and required documents to: , Payment Analyst

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

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:

1. During Award Year:

[Estimated Federal Cash Outlays To

Be Made]

PELL TEACH FSEOG FWS DL FPerkins

2. As of [Month (MM)/Day (DD)/Year (YY):

[Less Estimated Balance of Federal Cash On Hand]

PELL TEACH FSEOG FWS DL FPerkins

3. For Period From Month/Day/Year to Month/Day/Year

[Requested Amount Line A Minus B]

to

PELL TEACH FSEOG FWS DL FPerkins

FORM 1 of 2

Form 1 of 2

Institution Name and Address:

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

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 1226a-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 Certification Date:

Party Servicer Signature:

Legal Name Typed Phone:

or Printed:

Email Address:

Comptroller or Third Certification Date:

Party Servicer Signature:

Legal Name Typed Phone:

or Printed:

Email Address:

Form 2 of 2

FORM 270 (xx-xxxx)

AUTHORIZED FOR LOCAL REPRODUCTION