New York State Public Service Student Loan Forgiveness Customer Feedback Form

JavaScript is currently disabled in your web browser.
For full functionality of this site, it may be necessary to enable JavaScript. Here are instructions how to enable JavaScript.

You are using an outdated browser.
For full functionality of this site, you may need to upgrade your browser.

New York State Public Service Student Loan Forgiveness Customer Feedback Form

Language:

English

Spanish

* Indicates required fields

If you would like to view this online form in a different language, click on the button below to learn how to change the language in your browser settings.

TRANSLATION INFORMATION

New York State has enacted laws to assist public service employees who are having difficulty getting their employer (former or current) to sign the certification to qualify for federal public service student loan forgiveness. The NYS Department of Labor can assist such employees by reaching out to the public service employer.

Complete this form to file a complaint if your public service employer is refusing to sign the certification of employment to allow you to file for federal public service student loan forgiveness. (If form is submitted, email submits to wageandstandardscomplaints@labor.ny.gov)

A separate complaint form must be submitted for each additional Public Service Employer

* Indicates a required field

Contact Information

First Name

Last Name

Phone Number
(including area code)

Public Service Employer

Is this your current employer?

Yes

Business Address

Address Line 1

Address Line 2

City/Town (required)

State (required)

Zip Code

Business Phone Number (including area code)

Type of Business (required)

(e.g. State, agency of this state, city , county, village, township, school district,
institution of higher education.)

When did you request the certification for public service student loan forgiveness?

Business Contact

Who did you speak to at the employer?

Name

Title

Phone number

What was the response of the employer?

Please describe your complaint in detail (required)