OMB # 1845

- 0089

Expiration Date: xx/xx/xxxx

AUTHORIZED FOR LOCAL REPRODUCTION FORM 270 (xx

- 2015) 

# Request for Title IV Reimbursement

or Heightened Cash Monitoring 2 (HCM2)

A ny 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 T itle I V

, HEA student financial assistance programs. Since di f ferent

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 

# Form 270OMB # 1845

- 0089

Expiration Date: xx/xx/xxxx

AUTHORIZED FOR LOCAL REPRODUCTION FORM 270 (xx

- 2015) 

# Completing The Request for Title IV Reimbursement or Heightened Cash Monitoring 2

(HCM2) Form

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)

.

P a ge 2 of 4 

# INSTRUCTIONSOMB # 1845

- 0089

Expiration Date: xx/xx/xxxx

AUTHORIZED FOR LOCAL REPRODUCTION FORM 270 (xx

- 2015) 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 perio ds 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 cal culations, enter the required dollar amounts using only digits and a

decimal to separate cents (e.g., 1234567.89).

Page 3 of 4 

# INSTRUCTIONS

(continued)OMB # 1845

- 0089

Expiration Date: xx/xx/xxxx

AUTHORIZED FOR LOCAL REPRODUCTION FORM 270 (xx

- 2015)

W

ARNING & CE R TIFIC A TION S TA TEMENTS : Prior to certifying the Form 270 , read the warning and certification thoroughl y . 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 manual ly 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

-

Address

Page 4 of 4 

# INSTRUCTIONS

(continued)



# CE R TIFIC A TIONOMB # 1845

- 0089

Expiration Date: xx/xx/xxxx

AUTHORIZED FOR LOCAL REPRODUCTION FORM 270 (xx

- 2015)

1. Method of Payment Type: HCM2 Reimbursement

2. Institution Name and Address:

3. OPEID # 4. DUNS #

4. Department of Education

- Federal Student Aid

6. Computations:

A. During Award Year:

[Estimated Federal Cash Outlays To

Be Made]



### PELL TEACH FSEOG FWS DL FPerkins

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

[Less Estimated Balance of Federal Cash On Hand]

PELL TEACH FSEOG FWS DL 

### FPerkins

C. For Period From Month/Day/Year

t o Month/Day/Year

[Requested Amount Line A Minus B]



### to

PELL TEACH FSEOG FWS DL 

### FPerkins

FORM 1 of 2 

# Request for Title IV Reimbursement or

Heightened Cash Monitoring 2 (HCM2)OMB # 1845

- 0089

Expiration Date: xx/xx/xxxx

AUTHORIZED FOR LOCAL REPRODUCTION FORM 270 (xx

- 2015) Form 1 of 2

Institution Name and Address:

OPEID# DUNS #

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 co ntrol 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 nee ded, 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 regul ation: 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 appropri ate School Participation

Division using the contact information on page 4 of this form.

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.

Form 2 of 2 

# Request for Title IV Reimbursement or

Heightened Cash Monitoring 2 (HCM2)

PAPERWORK BURDEN STATEMENT

CE R TIFIC A TION

Comptroller or Third Party Servicer & President/Owner/Chief Executive Officer

CERTIFICATION : In accordance with the WARNING set out a bove 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 approp ri ate 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 pa yment to the institution of the funds requested

.

Comptroller or Third Certification Date:

Party Servicer Signature:

Legal Name Typed Phone:

or Printed:

Email Address: Comptroller o r Third Certification Date:

Party Servicer Signature:

Legal Name Typed Phone:

or Printed:

Email Address: