Application and Employment Certification for Public Service Loan Forgiveness Form

Application and Employment Certification for Public Service Loan Forgiveness

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0110 can be found here:

Documents and Forms

Document Name Document Type
Application and Employment Certification for Public Service Loan Forgiveness Form Form and Instruction
1845-0110 PSLF rev MOHELA.pdf Form and Instruction
1845-0110 PSLF rev MOHELA.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Application and Employment Certification for Public Service Loan Forgiveness Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	N/A	1845-0110 PSLF rev MOHELA.pdf		Yes	No	Printable Only

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: Common Services for Borrowers	FR Citation: 79 FR 117

Number of Respondents: 801,261	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	801,261	801,261
Annual IC Time Burden (Hours)	400,631	400,631
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.