Public Service Loan Forgiveness (Pslf): Employment Certification Form (Page 3 of 6) in pdf

SECTION 5: INSTRUCTIONS FOR COMPLETING THE FORM

You may submit information about multiple employers by submitting one copy of Sections 1 and 2 (Page 1), and one

copy of Sections 3 and 4 (Page 2) per employer. When completing this form, type or print using dark ink. Enter dates as

month-day-year (mm-dd-yyyy). Use only numbers. Example: March 14, 2014 = 03-14-2014. If any information is crossed

out or altered in Section 3, it must be initialed by your employer. For more information about PSLF and how to use this

form, visit StudentAid.gov/publicservice. Return the completed form to the address shown in Section 7.

SECTION 6: DEFINITIONS

§ A public service organization is:

§ AmeriCorps position means a position approved by the

o A Federal, State, local or Tribal government

Corporation for National and Community Service under

organization, agency or entity;

Section 123 of the National and Community Service Act

o A public child or family service agency;

of 1990 (42 U.S.C. 12573).

o A non-profit organization under Section 501(c)(3) of

§ An authorized official is an official of a public service

the Internal Revenue Code that is exempt from

organization (including AmeriCorps or the Peace Corps)

taxation under Section 501(a) of the Internal

who has access to the borrower’s employment or service

Revenue Code;

records and is authorized by the public service

o A Tribal college or university; or

organization to certify the employment status of the

o A private organization (that is not a business

organization’s employees or former employees, or the

organized for profit, a labor union, or a partisan

service of AmeriCorps or Peace Corps volunteers.

political organization) that provides at least one of

§ Eligible loans are loans that are not in default and made

the following public services: (1) emergency

under the William D. Ford Federal Direct Loan (Direct

management, (2) military service, (3) public safety,

Loan) Program.

(4) law enforcement, (5) public interest law services,

§ An employee means an individual who is hired and paid

(6) early childhood education (including licensed or

by a public service organization.

regulated child care, Head Start, and State funded

§ Full-time means working in qualifying employment in

pre-kindergarten), (7) public service for individuals

one or more jobs for the greater of:

with disabilities and the elderly, (8) public health

o An annual average of at least 30 hours per week or,

(including nurses, nurse practitioners, nurses in a

for a contractual or employment period of at least 8

clinical setting, and full-time professionals engaged in

months, an average of 30 hours per week; or

health care practitioner occupations and health

o Unless the qualifying employment is with two or

support occupations, as such terms are defined by

more employers, the number of hours the employer

the Bureau of Labor Statistics), (9) public education,

considers full time.

(10) public library services, (11) school library

§ An on-time payment is a payment made no more than

services, or (12) other school-based services.

15 days after the due date for the payment.

§ Qualifying payments are separate, on-time, full monthly

§ Law enforcement means service performed by an

payments made on a Direct Loan after October 1, 2007

employee of a public service organization that is publicly

under a qualifying repayment plan.

funded and whose principal activities pertain to crime

§ Qualifying employment includes an AmeriCorps position,

prevention, control or reduction of crime, or the

a Peace Corps position, or employment at a public

enforcement of criminal law.

service organization.

§ Military service for uniformed members of the U.S.

§ Qualifying repayment plans include:

Armed Forces or the National Guard means “active duty”

o The Income-Based Repayment Plan;

service or “full-time National Guard duty” as defined in

o The Pay As You Earn Plan;

Section 101(d)(1) and (d)(5) of Title 10 of the United

o The Income-Contingent Repayment Plan;

States Code, but does not include active duty for training

o The 10-Year Standard Repayment Plan (Standard

or attendance at a service school. For civilians, military

Repayment Plan with a maximum 10-year repayment

service means service on behalf of the U. S. Armed

period); and

Forces or the National Guard performed by an employee

o Any other Direct Loan repayment plan, but only if

of a public service organization.

payments are at least equal to the monthly payment

§ Peace Corps position means a full-time assignment

amount that would be required under the Standard

under the Peace Corps Act as provided for under 22

Repayment Plan with a 10-year repayment period.

U.S.C. 2504.

§ Public interest law refers to legal services provided by a

public service organization that are funded in whole or in

part by a local, State, Federal, or Tribal government.

Page 3 of 6

Public Service Loan Forgiveness (Pslf): Employment Certification Form Page 3

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