# STUDENT LOAN REPAYMENT PROGRAM POLICY

10 Purpose

20 References

30 Definitions

40 Coverage

50 Criteria for Justifying Federal Student Loan Repayment(s)

60 Requests for Student Loan Repayment

70 Service Agreements

80 Approval of Student Loan Repayment(s)

90 Responsibilities

100 Termination of Benefits

110 Waiver of Student Loan Indebtedness

120 Recordkeeping and Reporting Requirements

130 Evaluation of Program

> Appendix -1, Request for Student Loan Repayment Benefit Under the
> Student Loan Repayment Program
>
> Appendix -- 2, Student Loan Repayment Program Service Agreement
>
> Appendix -- 3, Student Loan Repayment Program Outstanding Loan
> Information Request
>
> Appendix -- 4, Waiver of Student Loan Indebtedness Information Request

**10 PURPOSE**

The Department of Health and Human Services' Student Loan Repayment
Program (SLRP) is established as a management tool to facilitate the
recruitment and retention of "highly qualified" candidates and
employees. The SLRP authorizes the repayment of all or part of an
outstanding federally-insured student loan obligation incurred by a
current employee or a candidate to whom an offer of employment has been
made. The decision to offer student loan repayment is an individual
compensation determination that is made on a case-by-case basis based on
organizational need, specific case justification, and budgetary
limitations without regard to political affiliation, race, color,
religion, national origin, sex, marital status, age or disabilities.

**NOTE:** The SLRP is not an entitlement and is to be used only to the
extent that is necessary for effective recruitment and retention
purposes.

**20 REFERENCES (Legal Authorities):**

A. 5 United States Code, § 5379

B. 5 Code of Federal Regulations, Part 537

C. Public Law 106-398 amending 5 USC 5379

D. Federal Register, Vol. 69, No. 76, Part 537, April 20, 2004

**30 DEFINITIONS**

**A. Student Loan** \-- A loan made, insured, or guaranteed under parts
B, D, or E of Title IV of the Higher Education Act of 1965; or a health
education assistance loan made or insured under Part A of Title VII of
the Public Health Service Act, or under Part E of Title VIII of that
Act.

**Loans covered under The Higher Education Act include such loans as:**

> 1\. Federal Stafford Loans \-- including Federal subsidized, Federal
> unsubsidized, direct subsidized, and direct unsubsidized loans;
>
> 2\. Federal Supplemental Loans for Students;
>
> 3\. Federal Plus Loans \-- Federal and Direct Plus Loans;
>
> 4\. Federal Consolidation Loans \-- direct subsidized, direct
> unsubsidized, and Federal Consolidation Loans;
>
> 5\. Defense Loans \-- made before July 1, 1972;
>
> 6\. National Direct Student Loans \-- made between 7/1/72 and 7/1/87;
>
> 7\. Federal Perkins Loans

**Loans covered under the Public Health Service Act include loans made
under:**

1\. The Nursing Student Loan Program;

2\. The Health Profession Student Loan Program; and

3\. The Health Education Assistance Loan Program

**B.** Federal Direct Student Loan \-- The U. S. Department of Education
is the lender for these loans. Direct Loans include Federal Direct PLUS
loans and Federal Direct Stafford loans.

**C.** Federal Family Education Loan Program \-- These loans are insured
by the Department of Education. Loans are privately issued by a bank,
credit union, or other lender that participates in the Federal Family
Education Loan Programs.

**D.** Subsidized Loan \-- The U.S. Government pays the interest on the
loan while the student is in school, during the 6-month grace period,
and during periods of authorized deferment.

**E.** Unsubsidized Loan \-- The student is responsible for paying the
interest accrued while the student is in school, during the 6-month
grace period, and during authorized periods of deferment.

**40 COVERAGE**

**A. Eligibility** -- Any "employee" as defined in 5 U.S.C. 2105, who is
highly qualified, is eligible to receive a student loan repayment. HHS
"employees" on the following types of appointments are eligible to be
considered for Federal student loan repayment assistance (see 5 CFR
537.104):

1.  Permanent employees;

2.  Employees serving on term appointments with at least 3 years
    remaining on their appointments;

3.  Employee serving in excepted appointments that can lead to
    non-competitive conversion to a term, career, or career-conditional
    appointments, e.g., Veterans Readjustment Appointments (VRAs), HHS
    Emerging Leaders, Presidential Management Fellows (PMF), etc.

4.  Temporary employees under 5 CFR 315.704 who are serving on
    appointments leading to conversion to term or permanent
    appointments;

5.  Employees serving on a full-time or part-time schedule.

**NOTE:** Employees receiving a Physicians Comparability Allowance (PCA)
under 5 CFR 595.105(e) are eligible. However, the amount of their PCA
must be reduced by an amount equal to any loan repayment assistance
received under this program.

**B.** The following employees are ***[ineligible]{.underline}*** for
the Federal Student Loan Repayment Program:

1.  Individuals whose student loans are past due, delinquent, or
    defaulted;

2.  Those appointed to positions of a confidential, policy determining,
    policy making, or policy advocating nature (e.g. under Schedule C or
    5 CFR 213.3301);

3.  Individuals who received their diplomas/degrees from unaccredited
    and/or fraudulent institutions (e.g. diploma mills).

**NOTE:** Commissioned Corp Officers in the Public Health Service are
not considered "employees" as per Title 5 U.S.C. 2105, and therefore are
ineligible to participate in the Student Loan Repayment Program.

**C. Maximum Repayment Amount --** Eligible employees may be considered
for loan repayment assistance up to \$10,000 per calendar year, with a
\$60,000 lifetime maximum for any individual. Individual loans are made
on an annual basis and more than one loan may be repaid so long as the
combined repayments do not exceed the annual and lifetime limits.

**50 CRITERIA FOR JUSTIFYING FEDERAL STUDENT LOAN REPAYMENT(s)**

**A. Recruitment -** Loan repayment may be authorized upon the
determination that, in the absence of loan repayment benefits, the
Operating Division (OPDIV) would have difficulty filling a position with
a highly qualified candidate. Evidence of need may be based on:

1\. The success of recent efforts to recruit suitable candidates for
similar positions, including such indicators as offer acceptance rates,
the proportion of positions filled, and the length of time required to
fill positions.

2\. Recent turnover in the same or similar positions.

3\. Labor market factors that affect the ability to recruit for similar
positions.

4\. Need to fill position requiring highly specialized skills or
qualifications.

**OPDIV managerial staff should consider the following criteria in
determining the amount of the Student Loan Repayment:**

a.  The severity of the recruiting problem.

b.  Salary levels reported in published salary surveys for comparable
    non-Federal positions.

c.  The criticality of the position to be filled and the effect on the
    OPDIV if it is not filled or if there is a delay in filling it.

d.  Current salary of the candidate.

e.  Salary documented in a competing job offer (if available).

f.  The disparity in cost-of-living between the candidate\'s current
    residence and the proposed duty station.

g.  The projected cost of further recruitment efforts if the candidate
    does not accept the position.

h.  The extent of the individual\'s past training and experience that
    serves to qualify him/her for the position.

    **NOTE:** Each determination for recruitment purposes (including the
    amount to be paid) must be made before the employee enters on duty.
    The Student Loan Repayment Program may not be used to recruit an
    individual from another Federal agency.

    **B. RETENTION**

    Loan repayment may be authorized upon determination that, in the
    absence of loan repayment benefits, the OPDIV would have difficulty
    retaining a highly qualified employee. Evidence of need may be based
    on:

    1\. The unique or high qualifications of the employee or the special
    need for the employee's skills that makes it essential to retain
    him/her.

    2\. The extent to which the employee's departure would affect the
    OPDIV\'s ability to carry out an activity or perform a function that
    is deemed essential to the Agency's mission.

**OPDIV managerial staff should consider the following criteria in
deciding the amount of the Student Loan Repayment:**

a.  Salary levels reported in published salary surveys for comparable
    non-Federal positions.

b.  Salary documented in a competing job offer.

c.  The criticality of the position and the effect on the OPDIV if the
    employee were to leave.

d.  The projected cost of recruitment and training associated with
    replacement of the employee.

e.  Employee's tenure with the OPDIV.

# 

**NOTE:** All determinations (Recruitment and Retention Student Loan
Repayment Requests) must be in writing and attached to the "Request for
Student Loan Repayment Benefit Under the Student Loan Repayment Program"
(See Appendix -1), and must document the criteria used to determine the
amount of the loan repayment benefit.

**60 REQUESTS FOR STUDENT LOAN REPAYMENT**

OPDIV managers/supervisors recommending an employee for a student loan
repayment benefit must complete the "Request for Student Loan Repayment
Program Under the Student Loan Repayment Program" document (see
Appendix - 1).

**70 SERVICE AGREEMENTS**

1\. Before a loan repayment may be made, the employee must sign a
Student Loan Repayment Program Service Agreement (see Appendix - 2)
acknowledging the requirement to serve a minimum of three years with the
OPDIV, regardless of the amount of repayment authorized. This three-year
period will begin when the first payment is made to the holder of the
loan. Any additional repayments made during this three-year period do
not extend the service agreement. However, if additional payments are
made [after]{.underline} the initial three-year agreement has been
completed, the service agreement will be extended by one year for each
payment made beyond the 3^rd^ year. The extended service agreement
period begins when the first payment beyond the 3^rd^ year is made to
the holder of the loan.

The agreement may also specify employment conditions considered
appropriate, e.g., employee's position and the duties he/she is expected
to perform, work schedule, or expected level of performance. The service
agreement in no way constitutes a right, promise, or entitlement for
continued employment or noncompetitive conversion to the competitive
service, nor does it limit management's right to take corrective or
disciplinary actions as otherwise appropriate.

2\. An employee who voluntarily leaves the OPDIV or is separated
involuntarily because of performance or misconduct and fails to complete
the agreed-upon period of service must refund the full amount of
benefits received during the initial three-year period. Employees who
fail to complete the period of service under an extension period, (e.g.,
4^th^ year, 5^th^ year) must repay the amount of the benefits received
in the extension year only. If an employee fails to reimburse the OPDIV,
the amount outstanding will be recovered from the employee under
established debt collection procedures.

**80 APPROVAL OF STUDENT LOAN REPAYMENT(s)**

Approval for student loan repayments will be made in accordance with
established OPDIV operating procedures.

**90 RESPONSIBILITIES**

**A.** [Operating Divisions (OPDIV)]{.underline}

1\. Funding: Each OPDIV is responsible for funding its own student loan
repayment program, and certification of funds must be obtained according
to established OPDIV budgetary procedures.

2\. Responsible Office: Each OPDIV will designate a SLRP coordinator
responsible for:

a.  Developing and disseminating operating procedures governing the

> OPDIV's use of the Department's Student Loan Repayment Program;

b.  Providing updates when changes are made to the laws governing the
    student loan repayment program;

c.  Consolidating OPDIV input for reporting purposes;

d.  Ensuring verification that the student loan is federally insured and
    loan balance before payment is authorized;

e.  Coordinating with lending institution(s); and

f.  Coordinating with the servicing Human Resources Center, and payroll
    function.

3\. Program Controls: Employees may have both eligible and ineligible
loans from the same lending institution; OPDIV's will institute
follow-up procedures with lenders to ensure that payments are made
correctly and only to eligible loans.

4\. OPDIV's will track participants to ensure that service agreements
are fulfilled, and recoupment procedures will be initiated when a
service agreement is not met unless a waiver is requested and approved.
(See Appendix -- 4)

5\. OPDIV's will review participants' loan balances annually to ensure
employees are paying his/her share of the debt before any additional SLR
is made on the employee's behalf.

6\. OPDIV's will confirm participants' performance appraisal prior to
each annual payment. (Employees must maintain the equivalent of a "fully
successful" performance appraisal to receive SLRP benefits.)

**B.** [Employees]{.underline}

1\. The employee is responsible for making payments on the portion of
the loan not covered by the HHS SLRP.

2\. Payments will be made annually in a single lump sum directly to the
financial institution holding the loan, and the employee must obtain a
statement from the financial institution stating that the loan is made,
insured, or guaranteed under one of the following: parts B, D or E of
Title IV of the Higher Education Act of 1965; or a health education
assistance loan made or insured under part A of Title VII of the Public
Health Service Act or under part E of Title VIII of that Act.
Verification that the loan is current (not past due), the loan number,
financial institution routing number for electronic transfer of funds
(if available) and the payoff amount as of a specific date should be
referenced on the statement as well.

**C.** [Human Resources Center(s) (HRC)]{.underline}

Withholding Taxes: The repayment of a student loan is taxable wages.
HRCs are responsible for ensuring that tax withholdings are deducted at
the time payment is made, e.g., federal income tax, FICA, Medicare
withholding, and any applicable state or local income tax.

**D.** [Assistant Secretary for Administration and Management, Office of
Human Resources (ASAM/OHR)]{.underline}

1\. ASAM/OHR must prepare a report before January 1 of each year of the
previous fiscal year's use of the Agency's student loan repayment
authority for submission to the Office of Personnel Management (OPM).
The report must contain

the number of HHS employees selected to receive the benefit, the job
classifications of the recipients, and the cost to the Federal
Government to provide the loan repayment.

**100 TERMINATION OF BENEFITS**

An employee receiving loan repayment benefits will be ineligible for
continued benefits if he/she separates from the OPDIV for any reason;
fails to maintain a fully satisfactory level of performance; or violates
any of the conditions of the service agreement.

**110 WAIVER OF STUDENT LOAN INDEBTEDNESS**

Repayment of student loan indebtedness may be wholly or partially waived
at the discretion of the OPDIV repaying the loan if recovery would be
against equity and good conscience or against the public interest. In
making the determination, the OPDIV will take into account consistency,
fairness, and the cost to the taxpayer of recovering monies owed to the
government.

Employees who meet the criteria for a waiver of their student loan
indebtedness must;

**1.** Complete a Waiver of Student Loan Indebtedness Information
Request document (Appendix -- 4).

**2.** Attach original Service Agreement (Appendix -- 2), along with the
loan balance from the lending institution, and written justification as
to why recovery of the debt would be against equity, good conscience,
and the public interest.

**3.** The documents will then be forwarded to the OPDIV approving
official for final approval according to OPDIV operating procedures.

If the waiver request is approved, the Payroll Office will suspend
collection of the debt; a personnel action will be generated by the
servicing Human Resources Center to terminate the debt collection, and
the employee and his/her supervisor will receive written notification
from the OPDIV approving official that the debt has been suspended.

**NOTE:** When an employee is separated by death or disability
retirement, or is unable to continue working because of disability
evidenced by acceptable medical documentation, repayment is
automatically waived.

**120 RECORDKEEPING AND REPORTING REQUIREMENTS**

As required in 5 CFR 537.110, OPDIV's must keep a record of each
determination made under this part and make such records available for
review upon the Department's request. These records may be destroyed
after three years or after OPM formally evaluates the program (whichever
comes first).

Before January 1 of each year, each OPDIV must submit a written report
to the Assistant Secretary for Administration and Management, Office of
Human Resources (ASAM/OHR) outlining their previous fiscal year's use of
the student loan repayment authority. This report must contain the
number of employees selected to receive this benefit; the job
classifications of the recipients; and the cost to the OPDIV for
providing the loan repayment.

**130 EVALUATION OF PROGRAM**

Each OPDIV will continually evaluate their participation in the program
in order to assess overall program effectiveness, and to ensure
regulatory compliance.

# 

# APPENDIX - 1, REQUEST FOR STUDENT LOAN REPAYMENT BENEFIT UNDER THE

# STUDENT LOAN REPAYMENT PROGRAM 5 U.S.C. 5379

+----------------------+---+-----+----------------+------+--------------+
| Name                 |   |     | Social         |      | Date         |
|                      |   |     | Security       |      | (MM/DD/YY)   |
|                      |   |     | Number         |      |              |
+----------------------+---+-----+----------------+------+--------------+
| Title                |   | Se  |                | Type |              |
|                      |   | rie |                | of   |              |
|                      |   | s/G |                | App  |              |
|                      |   | rad |                | oint |              |
|                      |   | e/S |                | ment |              |
|                      |   | tep |                | &    |              |
|                      |   |     |                | NTE  |              |
|                      |   |     |                | Date |              |
+----------------------+---+-----+----------------+------+--------------+
| Total Amount of      |   |     |                |      |              |
| Student Loan         |   |     |                |      |              |
| Repayment Benefit    |   |     |                |      |              |
| Received to Date     |   |     |                |      |              |
| (Include the         |   |     |                |      |              |
| Requested Amount     |   |     |                |      |              |
| from this Request    |   |     |                |      |              |
| Form.)               |   |     |                |      |              |
| \$\_\_\_\_\_\_\_\_   |   |     |                |      |              |
| \_\_\_\_\_\_\_\_\_\_ |   |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+
| Student Loan         | S |     |                |      |              |
| Repayment            | t |     |                |      |              |
|                      | u |     |                |      |              |
| Benefit Amount       | d |     |                |      |              |
| Requested:           | e |     |                |      |              |
|                      | n |     |                |      |              |
| \$\_\_\_\_\_         | t |     |                |      |              |
| \_\_\_\_\_\_\_\_\_\_ | L |     |                |      |              |
|                      | o |     |                |      |              |
|                      | a |     |                |      |              |
|                      | n |     |                |      |              |
|                      | R |     |                |      |              |
|                      | e |     |                |      |              |
|                      | p |     |                |      |              |
|                      | a |     |                |      |              |
|                      | y |     |                |      |              |
|                      | m |     |                |      |              |
|                      | e |     |                |      |              |
|                      | n |     |                |      |              |
|                      | t |     |                |      |              |
|                      | B |     |                |      |              |
|                      | e |     |                |      |              |
|                      | n |     |                |      |              |
|                      | e |     |                |      |              |
|                      | f |     |                |      |              |
|                      | i |     |                |      |              |
|                      | t |     |                |      |              |
|                      | f |     |                |      |              |
|                      | o |     |                |      |              |
|                      | r |     |                |      |              |
|                      | Y |     |                |      |              |
|                      | e |     |                |      |              |
|                      | a |     |                |      |              |
|                      | r |     |                |      |              |
|                      | N |     |                |      |              |
|                      | u |     |                |      |              |
|                      | m |     |                |      |              |
|                      | b |     |                |      |              |
|                      | e |     |                |      |              |
|                      | r |     |                |      |              |
|                      | : |     |                |      |              |
|                      | ( |     |                |      |              |
|                      | C |     |                |      |              |
|                      | i |     |                |      |              |
|                      | r |     |                |      |              |
|                      | c |     |                |      |              |
|                      | l |     |                |      |              |
|                      | e |     |                |      |              |
|                      | O |     |                |      |              |
|                      | n |     |                |      |              |
|                      | e |     |                |      |              |
|                      | ) |     |                |      |              |
|                      |   |     |                |      |              |
|                      | 1 |     |                |      |              |
|                      | 2 |     |                |      |              |
|                      | 3 |     |                |      |              |
|                      | 4 |     |                |      |              |
|                      | 5 |     |                |      |              |
|                      | 6 |     |                |      |              |
|                      | O |     |                |      |              |
|                      | t |     |                |      |              |
|                      | h |     |                |      |              |
|                      | e |     |                |      |              |
|                      | r |     |                |      |              |
|                      | \ |     |                |      |              |
|                      | _ |     |                |      |              |
|                      | \ |     |                |      |              |
|                      | _ |     |                |      |              |
|                      | \ |     |                |      |              |
|                      | _ |     |                |      |              |
|                      | \ |     |                |      |              |
|                      | _ |     |                |      |              |
|                      |   |     |                |      |              |
|                      | * |     |                |      |              |
|                      | * |     |                |      |              |
|                      | * |     |                |      |              |
|                      | N |     |                |      |              |
|                      | O |     |                |      |              |
|                      | T |     |                |      |              |
|                      | E |     |                |      |              |
|                      | : |     |                |      |              |
|                      | S |     |                |      |              |
|                      | e |     |                |      |              |
|                      | r |     |                |      |              |
|                      | v |     |                |      |              |
|                      | i |     |                |      |              |
|                      | c |     |                |      |              |
|                      | e |     |                |      |              |
|                      | A |     |                |      |              |
|                      | g |     |                |      |              |
|                      | r |     |                |      |              |
|                      | e |     |                |      |              |
|                      | e |     |                |      |              |
|                      | m |     |                |      |              |
|                      | e |     |                |      |              |
|                      | n |     |                |      |              |
|                      | t |     |                |      |              |
|                      | m |     |                |      |              |
|                      | u |     |                |      |              |
|                      | s |     |                |      |              |
|                      | t |     |                |      |              |
|                      | b |     |                |      |              |
|                      | e |     |                |      |              |
|                      | a |     |                |      |              |
|                      | t |     |                |      |              |
|                      | t |     |                |      |              |
|                      | a |     |                |      |              |
|                      | c |     |                |      |              |
|                      | h |     |                |      |              |
|                      | e |     |                |      |              |
|                      | d |     |                |      |              |
|                      | t |     |                |      |              |
|                      | o |     |                |      |              |
|                      | t |     |                |      |              |
|                      | h |     |                |      |              |
|                      | i |     |                |      |              |
|                      | s |     |                |      |              |
|                      | R |     |                |      |              |
|                      | e |     |                |      |              |
|                      | q |     |                |      |              |
|                      | u |     |                |      |              |
|                      | e |     |                |      |              |
|                      | s |     |                |      |              |
|                      | t |     |                |      |              |
|                      | f |     |                |      |              |
|                      | o |     |                |      |              |
|                      | r |     |                |      |              |
|                      | m |     |                |      |              |
|                      | . |     |                |      |              |
|                      | * |     |                |      |              |
|                      | * |     |                |      |              |
|                      | * |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+
| Current Balance of   |   |     |                |      |              |
| Outstanding Loan:    |   |     |                |      |              |
| \$\_\_\_\_\_\_\_     |   |     |                |      |              |
| \_\_\_\_\_\_\_\_\_\_ |   |     |                |      |              |
|                      |   |     |                |      |              |
| ***NOTE: Official    |   |     |                |      |              |
| Documentation from   |   |     |                |      |              |
| loan holder          |   |     |                |      |              |
| documenting loan     |   |     |                |      |              |
| balance and type of  |   |     |                |      |              |
| loan must be         |   |     |                |      |              |
| attached to this     |   |     |                |      |              |
| Request form.***     |   |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+
| **Compensation\*:**  |   |     |                |      |              |
|                      |   |     |                |      |              |
| #  Base/Localit      |   |     |                |      |              |
| y Pay \$ \_\_\_\_\_\ |   |     |                |      |              |
| _\_\_\_\_\_\_\_\_\_  |   |     |                |      |              |
|                      |   |     |                |      |              |
| Other Continuing     |   |     |                |      |              |
| Pay, (e.g., PDP,     |   |     |                |      |              |
| retention allowance) |   |     |                |      |              |
| \$                   |   |     |                |      |              |
| \_\_\_\_\_           |   |     |                |      |              |
| \_\_\_\_\_\_\_\_\_\_ |   |     |                |      |              |
|                      |   |     |                |      |              |
| #  \* Physi          |   |     |                |      |              |
| cian's Comparability |   |     |                |      |              |
|  Allowance (if appli |   |     |                |      |              |
| cable) \$ \_\_\_\_\_ |   |     |                |      |              |
| \_\_\_\_\_\_\_\_\_\_ |   |     |                |      |              |
|                      |   |     |                |      |              |
| Other Payments,      |   |     |                |      |              |
| e.g., lump sum       |   |     |                |      |              |
| payments \$          |   |     |                |      |              |
| \_\_\_\_\_           |   |     |                |      |              |
| \_\_\_\_\_\_\_\_\_\_ |   |     |                |      |              |
|                      |   |     |                |      |              |
| Student Loan         |   |     |                |      |              |
| Repayment Benefit    |   |     |                |      |              |
| Amount \$            |   |     |                |      |              |
| \_\_\_\_\_           |   |     |                |      |              |
| \_\_\_\_\_\_\_\_\_\_ |   |     |                |      |              |
|                      |   |     |                |      |              |
| **TOTAL              |   |     |                |      |              |
| COMPENSATION** **\$  |   |     |                |      |              |
| \_\_\_\_             |   |     |                |      |              |
| \_\_\_\_\_\_\_\_\_** |   |     |                |      |              |
|                      |   |     |                |      |              |
| \* Total Title 5     |   |     |                |      |              |
| compensation cannot  |   |     |                |      |              |
| exceed Executive     |   |     |                |      |              |
| Level 1 salary per   |   |     |                |      |              |
| calendar year.       |   |     |                |      |              |
|                      |   |     |                |      |              |
| \*\* Physician's     |   |     |                |      |              |
| Comparability        |   |     |                |      |              |
| Allowance must be    |   |     |                |      |              |
| reduced by the       |   |     |                |      |              |
| amount equal to the  |   |     |                |      |              |
| loan repayment       |   |     |                |      |              |
| assistance (5 CFR    |   |     |                |      |              |
| 595.105).            |   |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+
| ### Recommending     |   |     |                |      |              |
|  Official Title Date |   |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+
| ### Certification    |   |     |                |      |              |
|  of Funds Title Date |   |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+
| ### Approving        |   |     |                |      |              |
|  Official Title Date |   |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+
| ### Human Resources  |   |     |                |      |              |
|  Official Title Date |   |     |                |      |              |
+----------------------+---+-----+----------------+------+--------------+

# 

# APPENDIX - 2, STUDENT LOAN REPAYMENT PROGRAM SERVICE AGREEMENT

  ----------------------------- --------------------- ---------- ---------
  NAME (Print or Type -- First  SOCIAL SECURITY       OPDIV      DATE
  Middle Last)                  NUMBER                           

  ----------------------------- --------------------- ---------- ---------

In consideration of the student loan repayment benefit for which I
qualify under 5 U.S.C. 5379 as implemented by the regulations of the
U.S. Office of Personnel Management (5 CFR, Part 537), the policies of
the Department of Health and Human Services, and the OPDIV
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, I
hereby agree:

1.  To serve in
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
    for 3 years (initial contract) or 1 year (extensions). (OPDIV)

2.  The amount of the student loan repayment benefit is
    \$\_\_\_\_\_\_\_\_\_\_\_ (up to \$10,000). I understand that the
    commitment to repay my loan is for one year, subject to yearly
    extensions.

3.  If student loan repayment benefits are made in the 2^nd^ or 3^rd^
    year, my service agreement will not be extended.

4.  If student loan repayment benefits are made beyond 3 years, my
    service agreement will be extended by one year for each payment made
    beyond the 3^rd^ year.

5.  The service agreement is effective
    **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** through .

> (Month/Day/Year) (Month/Day/Year)

6.  This service agreement in no way constitutes a right, promise, or
    entitlement for continued employment or noncompetitive conversion to
    the competitive service. That acceptance of this agreement does not
    alter the conditions or terms of my employment; accordingly, this
    agreement will not preclude nor limit the Agency from effecting
    personnel actions as may be appropriate.

7.  That in the event I voluntarily leave the OPDIV, or in the event
    that I am involuntarily separated for misconduct or performance
    before completing the agreed upon period of service, I will be
    indebted to the Federal Government and must reimburse the OPDIV for
    the full amount of any student loan repayment benefits received
    under this service agreement.

8.  I am responsible for making loan payments on the portion of the loan
    that continues to be my responsibility.

9.  The student loan repayment benefits made do not exempt me from my
    responsibility and/or liability for the loan.

10. I am responsible for any income tax obligation resulting from the
    student loan repayment benefit.

11. HHS/\_\_\_\_\_\_\_\_\_\_\_ is not responsible for any late fees
    assessed by the lender if the student loan repayment benefit is not
    received on time.

12. The student loan repayment benefits made on my behalf from the
    Federal Government have/will not exceed \$10,000 per annum and
    \$60,000 in total.

**APPENDIX - 2 (Continued)**

13\. Other condition(s) agreed to by employee and the OPDIV:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**I AGREE TO THE TERMS OF THIS SERVICE AGREEMENT**:

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name (Print/Type)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**General**

This information is provided pursuant to the Privacy Act of 1974 (P.L.
93-597).

**Authority for Collection of Information**

5 U.S.C 5379 and 31 U.S.C. Section 7701(c)

**Purpose and Uses**

The main purpose for collecting the information requested on the above
mentioned form is to establish the terms under which an individual
receives a student loan repayment benefit under the Student Loan
Repayment Program. The information collected will be used as a basis for
payroll actions. Accordingly, disclosure of identifiable information,
including your Social Security Number (SSN), may be made to the Internal
Revenue Service for tax withholding purposes, the Department of Treasury
for payroll action, and to the Department of Labor for worker
compensation claims. This information may also be disclosed to the
Department of Justice for other lawful purposes including law
enforcement and in the event of litigation. In addition, these records,
or information there from, may also be used within DHHS for study
purposes, such as projection of staffing needs, and/or creation of
non-identifiable statistical data for reports to other Federal agencies
and Congress.

**Information Regarding Disclosure of Your Social Security Account
Number**

Disclosure of the SSN is mandatory since it is the identifier used by
the Internal Revenue Service and for the withholding of taxes from your
salary. The use of the SSN is made necessary because of the large number
of present and former employees and applicants who have identical names
and birth dates, and whose identities can only be distinguished by the
SSN. It is used primarily to identify an employee\'s personnel, leave,
and pay records and to relate on to the other. In this regard, it is
also used by the HHS to locate records in order to respond to lawful
requests for information from former employers, educational institutes,
and financial or other organizations. The information gathered through
the use of the number will be used only as necessary in personnel
administration processes carried out in accordance with established
regulations and published notices of systems of records. The SSN also
will be used for the selection of persons to be included in statistical
studies of personnel management matters.

**Effect of Non-disclosure**

Your submission of this agreement is voluntary; however, if the
agreement is submitted, omission of significant information requested
would preclude continued processing of the agreement for you to receive
payment because payroll would be unable to process the necessary
actions.

#### Human Resources Review:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_

(Signature) (Print Name) Date

# 

# APPENDIX - 3, STUDENT LOAN REPAYMENT PROGRAM, OUTSTANDING LOAN INFORMATION REQUEST

NAME: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SSN: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

The following information is required for each lender of a loan(s) being
considered under the Student Loan Repayment Program.

**1. Loan Information\*:**

a.  Name of the federally funded loan received, e.g., Federal Stafford
    Loan, Federal PLUS Loan, Federally Insured Student Loan, etc.
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

b.  Date Loan was Obtained \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> c\. Remaining Balance of Loan
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\*An official document/letter from the loan institution providing the
above loan information

must be attached to this form.

2.  **Name, address, and telephone number for the lending institution
    holder of the loan, i.e., bank, educational institution, etc.**

> Name
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Address
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> City/State
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Telephone
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

EFT Routing Number
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  **Name, address, and telephone number of servicing agent of the loan
    to whom payments are sent (if different from #2).**

> Name
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Address
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> City/State
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Telephone Number
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> EFT Routing Number
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4.  **Name, job title, and telephone number of authorized official for
    the Lending Institution.**

> Name \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Job Title \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone Number **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

5.  **Federal Tax Identification Number or EIN (Required for sending
    payments).**

> \_\_\_ \_\_\_\--\_\_\_ \_\_\_ \_\_\_ \_\_\_ \_\_\_ \_\_\_ \_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_\_\_\_**

**Name (Approving Official) Title Date**

**APPENDIX - 4, WAIVER OF STUDENT LOAN INDEBTNESS INFORMATION REQUEST**

Attach a copy of the Student Loan Repayment Service Agreement and the
loan balance information from the lending institution to this form.
Return form to the employing Human Resources Center and/or Department.

  --------------------------- ---------------------- ---------------------
  Employee Name (Last, First, Social Security Number Date (MM/DD/YY)
  MI)                                                

  Job Title                   Agency                 Outstanding Loan
                                                     Balance
  --------------------------- ---------------------- ---------------------

**Reason for Requesting Waiver of Student Loan Indebtedness:** (Explain
why the recovery of this debt would be against equity and good
conscience or against the public interest). Note: Repayment is
automatically waived for those employees separated by death or
disability retirement, or an inability to continue working because of
disability evidenced by acceptable medical documentation).

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ----------------------------- --------------------------- -------------
  OPDIV Approval Signature      Print Name                  Date

  ----------------------------- --------------------------- -------------

**Waiver Approved**: Yes \_\_\_\_\_\_\_\_\_ No \_\_\_\_\_\_\_\_\_

# 

#