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SECTION 1: BORROWER IDENTIFICATION |
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Please enter or correct the following information. SSN |__|__|__|-|__|__|-|__|__|__|__| |
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Name |
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Address |
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City, State, Zip Code |
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Telephone - Home ( ) |
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Telephone - Other ( ) |
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E-mail Address (Optional) |
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SECTION 2: DEFERMENT REQUEST |
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Before answering any questions, carefully read the entire form, including the instructions and other information in Sections 4, 5, and 6.
(1) I became unemployed or began working less than full time (see definition in Section 5) on |__|__|-|__|__|-|__|__|__|__|. Except as explained in Section 3, my deferment begins on this date, unless I request my deferment to begin on the following later date: |__|__|-|__|__|-|__|__|__|__|.(2) Check ONE of the boxes below: (A) I am diligently seeking but unable to find full-time employment in the United States (see definitions in Section 5) in any field or at any salary or responsibility level. I am registered with a public or private employment agency if there is one within 50 miles of my current address. Further, if I am requesting an extension of an existing unemployment deferment, I have made at least 6 diligent attempts to find full-time employment in the most recent 6 months. NOTE: School placement offices and “temporary” agencies do not qualify as public or private employment agencies. OR (B) I am eligible for unemployment benefits, and I have attached documentation of my eligibility for these benefits. The documentation includes my name, address, and social security number, and shows that I am eligible to receive unemployment benefits during the period for which I am requesting deferment. |
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SECTION 3: BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION |
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(1) I am not required to make payments of loan principal during my deferment. Interest will not be charged on my subsidized loan(s) during my deferment. However, interest will be charged on my unsubsidized loan(s). (2) I have the option of paying the interest that accrues on my unsubsidized loan(s) during my deferment. (3) I may choose to make interest payments by checking the box below. My loan holder may capitalize interest that I do not pay during the deferment period. I wish to make interest payments on my unsubsidized loan(s) during my deferment. (4) My deferment will begin on the date the condition that qualifies me for the deferment began, as shown in Section 2, Item (1), unless I request my deferment to begin on a later date. However, if this is my first unemployment deferment request for my current period of unemployment and I am not providing documentation of my eligibility for unemployment benefits, my deferment will begin no more than 6 months before the date my loan holder receives this request, even if I became unemployed or began working less than full time more than 6 months ago. (5) My deferment will end on the earlier of the date that the condition that establishes my deferment eligibility ends or the date on which I exhaust my maximum cumulative eligibility as explained in Section 6. (6) My deferment will last for no more than 6 months after the date my loan holder receives the deferment request. I must reapply every 6 months. (7) My loan holder will not grant this deferment request unless all applicable sections of this form are completed and any required additional documentation is provided. (8) If my deferment does not cover all my past due payments, my loan holder may grant me a forbearance for all payments due before the begin date of my deferment or—if the period for which I am eligible for a deferment has ended—a forbearance for all payments due at the time my deferment request is processed. (9) My loan holder may grant me a forbearance on my loans for up to 60 days, if necessary, for the collection and processing of documentation related to my deferment request. Interest that accrues during this forbearance will not be capitalized.
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Borrower’s Signature |
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SECTION 4: INSTRUCTIONS FOR COMPLETING THE FORM |
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Type or print using dark ink. Report dates as month-day-year (MM-DD-YYYY). For example, ‘January 31, 2009’ = ‘01-31-2009’. If you are qualifying for this deferment by documenting your eligibility for unemployment benefits, attach the documentation to this form. If you need help completing this form, contact your loan holder. Return the completed form and any required documentation to the address shown in Section 7. |
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SECTION 5: DEFINITIONS |
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*Total amount repaid includes $1,350 of interest paid during the 12-month period of deferment.
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SECTION 6: ELIGIBILITY CRITERIA FOR UNEMPLOYMENT DEFERMENT |
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SECTION 7: WHERE TO SEND THE COMPLETED DEFERMENT REQUEST |
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Return the completed deferment request and any required documentation to: (If no address is shown, return to your loan holder.)
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If you need help completing this form, call: (If no telephone number is shown, call your loan holder.)
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SECTION 8: 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. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1071 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 Program (FFELP) 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 FFELP, 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) becomes 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 NoticeAccording 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 1845-0005. The time required to complete this information collection is estimated to average 0.16 hours (10 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 20202-4537 If you have questions regarding the status of your individual submission of this form, write directly to the address shown in Section 7. |
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File Type | application/msword |
File Title | ED SEAL |
Author | epjutz |
Last Modified By | Authorised User |
File Modified | 2009-05-06 |
File Created | 2009-05-06 |