MIL |
OMB
No. 1845-NEW Form
Approved Exp.
Date XX/XX/XXXX MILITARY DEFERMENT REQUEST Federal Family Education Loan Program / William D. Ford Federal Direct Loan Program / Federal Perkins Loan Program Use this form only for Federal Family Education Loan Program, William D. Ford Federal Direct Loan Program, or Federal Perkins Loan Program loans first disbursed on or after July 1, 2001,and Federal Consolidation Loans or Direct Consolidation Loans only if all of the Title IV loans included in the consolidation loan were first disbursed on or after July 1, 2001. WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying documents will be subject to penalties which may include fines, imprisonment or both, under the U.S. Criminal Code and 20 U.S.C. 1097. |
|
|||||||||||||||||||||||||||||||||
SECTION 1: BORROWER IDENTIFICATION |
|||||||||||||||||||||||||||||||||||
|
Please enter or correct the following information. |
||||||||||||||||||||||||||||||||||
|
SSN |
|
|
|
- |
|
|
- |
|
|
|
|
|||||||||||||||||||||||
|
Name |
|
|||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||
|
Address |
|
|||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||
|
City, State, Zip |
|
|||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||
|
Telephone – Home ( ) |
|
|||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||
|
Telephone – Other ( ) |
|
|||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||
|
E-mail Address (Optional) |
|
|||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||
SECTION 2: DEFERMENT REQUEST |
|||||||||||||||||||||||||||||||||||
Carefully read the entire form, including the instructions and other information in Sections 5, 6, and 7. A representative may complete and sign this form on your behalf if you are unable to do so. I meet the qualifications stated in Section 7 for this deferment and request that my loan holder defer repayment of my eligible loan(s) for a period not to exceed three years while I am either:
|
|||||||||||||||||||||||||||||||||||
SECTION 3: BORROWER UNDERSTANDINGS AND CERTIFICATIONS |
|||||||||||||||||||||||||||||||||||
I understand that:
I certify that: (1) The information I provided in Section 1 above is true and correct. (2) I will provide additional documentation to my loan holder, as required, to support my eligibility for this deferment. (3) I will notify my loan holder immediately if I stop performing the military duty that qualifies me for this deferment or I otherwise become ineligible for this deferment. (4) I have read, understand, and meet the eligibility criteria for this deferment, as stated in Section 2 and explained in Section 7. |
|||||||||||||||||||||||||||||||||||
Signature of Borrower or Borrower’s Representative |
|
Date |
|
||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
Printed Name of Borrower’s Representative (if applicable) |
|
Relationship to Borrower |
|
||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
Address of Borrower’s Representative |
|
Telephone ( ) |
|
||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
SECTION 4: AUTHORIZED OFFICIAL’S CERTIFICATION |
|||||||||||||||||||||||||||||||||||
Note: As an alternative to completing this section, a written statement from the commanding or personnel officer or a copy of the military orders may be attached. I certify, to the best of my knowledge and belief, that the borrower named above is/was engaged in the service described in Sections 2, 6, and 7 that begins/began on |__|__|-|__|__|-|__|__|__|__| and ends/ended on |__|__|-|__|__|-|__|__|__|__|. Enter dates as month-day-year (mm-dd-yyyy). |
|||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
Name of Military Branch or National Guard |
|
||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
Address |
|
City, State, Zip |
|
||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
Name/Title of Authorized Official |
|
Telephone ( ) |
|
||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
Authorized Official’s Signature |
|
Date |
|
SECTION 5: INSTRUCTIONS FOR COMPLETING THE FORM |
Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Use only numbers. Example: January 1, 2008 = 01-01-2008. In order to establish your eligibility, (1) an authorized official must complete section 4, or (2) a copy of your military orders or a written statement from your commanding or personnel officer must be attached. If you need help completing this form, contact your loan holder. If you are applying for a deferment of loans that are held by different loan holders, you must submit a separate deferment request to each loan holder. Return the completed form and any required documentation to the address shown in Section 8. |
SECTION 6: DEFINITIONS |
|
SECTION 7: ELIGIBILITY CRITERIA FOR MILITARY DEFERMENT |
|
SECTION 8: WHERE TO SEND THE COMPLETED DEFERMENT REQUEST |
|
Return the completed deferment request and any required documentation to: (If no address is shown, return to your loan holder.)
|
If you need help completing this form, call: (If no telephone number is shown, call your loan holder.) |
SECTION 9: IMPORTANT NOTICES |
|
Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice be provided to you: The authority for collecting the requested information from and about you is §421 et seq., §451 et seq., and/or §461 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1071 et seq., 20 U.S.C. 1087a et seq., and/or 20 U.S.C. 1087aa et seq.), and the authorities for collecting and using your Social Security Number (SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and 31 U.S.C. 7701(b). Participating in the Federal Family Education Loan (FFEL) Program, William D. Ford Federal Direct Loan (Direct Loan) Program, and Federal Perkins Loan (Perkins) Program and giving us your SSN are voluntary, but you must provide the requested information, including your SSN, to participate. The principal purposes for collecting the information on this form, including your SSN, are to verify your identity, to determine your eligibility to receive a loan or a benefit on a loan (such as a deferment, forbearance, discharge, or forgiveness) under the FFEL Program, Direct Loan Program, and/or Perkins Program, to permit the servicing of your loan(s), and, if it becomes necessary, to locate you and to collect and report on your loan(s) if your loan(s) become delinquent or in default. We also use your SSN as an account identifier and to permit you to access your account information electronically. The information in your file may be disclosed, on a case-by-case basis or under a computer matching program, to third parties as authorized under routine uses in the appropriate systems of records notices. The routine uses of this information include, but are not limited to, its disclosure to federal, state, or local agencies, to private parties such as relatives, present and former employers, business and personal associates, to consumer reporting agencies, to financial and educational institutions, and to guaranty agencies in order to verify your identity, to determine your eligibility to receive a loan or a benefit on a loan, to permit the servicing or collection of your loan(s), to enforce the terms of the loan(s), to investigate possible fraud and to verify compliance with federal student financial aid program regulations, or to locate you if you become delinquent in your loan payments or if you default. To provide default rate calculations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to state agencies. To provide financial aid history information, disclosures may be made to educational institutions. To assist program administrators with tracking refunds and cancellations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal or state agencies. To provide a standardized method for educational institutions to efficiently submit student enrollment status, disclosures may be made to guaranty agencies or to financial and educational institutions. To counsel you in repayment efforts, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal, state, or local agencies. In the event of litigation, we may send records to the Department of Justice, a court, adjudicative body, counsel, party, or witness if the disclosure is relevant and necessary to the litigation. If this information, either alone or with other information, indicates a potential violation of law, we may send it to the appropriate authority for action. We may send information to members of Congress if you ask them to help you with federal student aid questions. In circumstances involving employment complaints, grievances, or disciplinary actions, we may disclose relevant records to adjudicate or investigate the issues. If provided for by a collective bargaining agreement, we may disclose records to a labor organization recognized under 5 U.S.C. Chapter 71. Disclosures may be made to our contractors for the purpose of performing any programmatic function that requires disclosure of records. Before making any such disclosure, we will require the contractor to maintain Privacy Act safeguards. Disclosures may also be made to qualified researchers under Privacy Act safeguards. Paperwork Reduction Notice. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 1845-new. The time required to complete this information collection is estimated to average 0.5 hours (30 minutes) per response, including the time to review instructions, search existing data resources, gather and maintain the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education Washington, DC 20202-4700
If you have questions regarding the status of your individual submission of this form, contact your loan holder (see Section 8).
|
Page
File Type | application/msword |
File Title | CLO.FFEL-DL-P.rev8 |
Author | EPJUTZ |
Last Modified By | kate.mullan |
File Modified | 2007-04-09 |
File Created | 2007-04-09 |