A qualified taxpayer requesting that the Commission certify a tax credit shall apply to the Commission as provided in this regulation. A qualified taxpayer shall submit a signed application, on a form prepared by the Commission in accordance with §C of this regulation, for a Student Loan Debt Relief Tax Credit by September 15 of the tax year in which the taxpayer seeks to apply a Student Loan Debt Relief Tax Credit to the taxpayer’s income tax return. The Student Loan Debt Relief Tax Credit application shall require a qualified taxpayer to submit, in a form prescribed by the Secretary, information required by the Secretary to determine the taxpayer’s eligibility for certification, including but not limited to: The qualified taxpayer’s full legal name, date of birth, residency address, email address, phone number, and social security number; The name of the institution or institutions attended, date the qualified taxpayer’s degree or degrees were awarded, and dates of attendance attributable to the qualified taxpayer’s student loan debt; A statement attesting that the qualified taxpayer has: Incurred at least $20,000 in student loan debt; and At least $5,000 in outstanding student loan debt at the time the application is submitted; For each student loan debt that contributes to the amount of student loan debt attested to pursuant to §C(3) of this regulation the: Name, address, and phone number of the entity that provided the student loan debt; Account numbers associated with the student loan debt; Full names of all persons legally responsible for repaying the student loan debt; Original amount of the student loan debt disbursed to the qualified taxpayer; and; Total amount of the student loan debt currently outstanding at the time the Student Loan Debt Relief Tax Credit application is submitted; Information that the Secretary deems necessary in order to allow the Commission to determine the qualified taxpayer's debt burden; Information that the Secretary deems necessary in order to allow the Commission to determine the qualified taxpayer's adjusted gross income; A signed statement by the qualified taxpayer under penalty of perjury attesting that the information submitted in the application is true and correct to the knowledge and belief of the qualified taxpayer; A signed statement by the qualified taxpayer authorizing a lender or educational institution to release personal academic or financial information as may be requested by the Commission in processing the qualified taxpayer’s application; and A signed statement of assurance by the qualified taxpayer that the individual shall use any credit approved by the Commission and accepted by the Comptroller for the repayment of the individual’s student loan debt as soon as practicable and not later than 3 years after the taxable year in which the credit is claimed. By December 15 of the year in which a qualified taxpayer has submitted an application under §B of this regulation, the Commission shall certify to the individual the amount of any tax credit approved by the Commission as provided in Regulation .05 of this chapter.