Direct Loan Program Public Service Deferment Request (18

OMB No. 1845-0011 Form Approved Exp. Date xx/xx/xxxx PUB

PUBLIC SERVICE DEFERMENT REQUEST William D. Ford Federal Direct Loan Program WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying documents is subject to penalties that 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

DRAFT 02-18-2009

City, State, Zip

Telephone - Home ( )

Telephone - Other ( )

E-mail (optional)

SECTION 2: DEFERMENT REQUEST

Before completing this form, carefully read the entire form, including the instructions and other information in Sections 5, 6, and 7. EXCEPT AS EXPLAINED IN SECTION 7, YOU MUST HAVE AN AUTHORIZED OFFICIAL COMPLETE SECTION 4. NOTE: You are eligible for these deferments only if, at the time you received your first Direct Loan, you had an outstanding balance on a Federal Family Education Loan (FFEL) Program loan that was made before July 1, 1993.  I meet the qualifications stated in Section 7 for the deferment checked below and request that the U.S. Department of Education (ED) defer repayment of my loan(s) while I am: On active duty in the ARMED FORCES of the United States. Serving full time as an officer in the Commissioned Corps of the PUBLIC HEALTH SERVICE. Serving in the PEACE CORPS. A full-time paid volunteer in the ACTION PROGRAMS. (If you are unsure whether your program is an ACTION program, check with your program director.) A full-time paid volunteer for a TAX-EXEMPT ORGANIZATION. On active duty in the NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION (NOAA). (NOTE: Direct PLUS Loan and Direct PLUS Consolidation Loan borrowers are not eligible for this deferment.)

SECTION 3: BORROWER UNDERSTANDINGS, CERTIFICATIONS AND AUTHORIZATION

 I understand that the following terms and conditions apply to this deferment: (1) I am not required to make payments of loan principal during my deferment. No interest will be charged on my subsidized loan(s) during my deferment. However, interest will be charged on my unsubsidized loan(s). For any unsubsidized loan(s), I will receive an interest statement, and I may pay the interest at any time. If I do not pay the interest that accrues on my unsubsidized loan(s), it will be capitalized at the end of my deferment period. (2) My deferment will begin on the date I began performing the public service that qualifies me for the deferment, as certified by the authorized official who completes Section 4 of this form. (3) My deferment will end on the earlier of (A) the date that I stop performing the public service that qualifies me for the deferment, or (B) the ending date of my qualifying public service, as certified by the authorized official who completes Section 4 of this form. (4) If my deferment does not cover all of my past due payments, ED may grant me a forbearance for all payments that were due before the begin date of my deferment. If the period for which I am eligible for a deferment has ended, ED may grant me a forbearance for all payments that are due at the time my deferment request is processed. (5) ED 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. ED will not capitalize interest that accrues during this forbearance.  I certify that: (1) The information I have provided on this form is true and correct. (2) At the time I obtained my first Direct Loan, I had an outstanding balance on a FFEL Program loan that was made before July 1, 1993. (3) I will provide additional documentation to the Direct Loan Servicing Center, as required, to support my eligibility for this deferment. (4) I will notify the Direct Loan Servicing Center immediately if I stop performing the public service that qualifies me for this deferment. (5) I have read, understand, and meet the eligibility requirements of the deferment for which I have applied. I authorize my schools, ED, and their respective agents and contractors to contact me regarding my loan request or my loan, including repayment of my loan, at the current or any future number that I provide for my cellular telephone or other wireless device using automated dialing equipment or artificial or prerecorded voice or text messages.

BORROWER’S SIGNATURE

DATE

SECTION 4: AUTHORIZED OFFICIAL’S CERTIFICATION

I certify, to the best of my knowledge and belief, that the borrower named above is performing or performed the public service indicated in Section 2, and that the borrower and the borrower’s service meet all the eligibility requirements specified in Section 7. The borrower’s service began on (month-day-year) |__|__|-|__|__|-|__|__|__|__| and is expected to end/ended on |__|__|-|__|__|-|__|__|__|__|.

Organization’s Name

Address

City, State, Zip

Name/Title of Authorized Official

Telephone ( )

AUTHORIZED OFFICIAL’S SIGNATURE

DATE

SECTION 5: INSTRUCTIONS
Type or print using dark ink. Report dates as month-day-year. For example, show “January 31, 2009” as “01-31-2009”. Include your name and social security number (SSN) on any attached documentation. REMEMBER TO SIGN AND DATE THE FORM AND (IF REQUIRED) HAVE AN AUTHORIZED OFFICIAL COMPLETE SECTION 4.
Send the completed form and any required documentation to: U.S. Department of Education Direct Loan Servicing Center P.O. Box 5609 Greenville, TX 75406-5609	If you need help completing this form, call: 1-800-848-0979. If you use a telecommunications device for the deaf (TDD), call: 1-800-848-0983. Direct Loan Servicing Center web site: www.dl.ed.gov
SECTION 6: DEFINITIONS
 An authorized official who may complete Section 4 is your Commanding or Personnel Officer (Armed Forces Deferment) or an authorized official of the U.S. Public Health Service, Peace Corps, ACTION Programs, tax-exempt organization, or NOAA.  If unpaid interest is capitalized, this means that it is added to the principal balance of your loan(s). This will increase the principal amount and the total cost of your loan(s).  A deferment allows you to temporarily postpone making payments on your loan(s). No interest is charged during a deferment on Direct Subsidized Loans and Direct Subsidized Consolidation Loans. Interest is charged during a deferment on all other Direct Loans.  The Federal Family Education Loan (FFEL) Program includes Federal Stafford Loans (both subsidized and unsubsidized), Federal Supplemental Loans for Students (SLS), Federal PLUS Loans, and Federal Consolidation Loans.  A forbearance allows you to temporarily postpone making payments on your loan(s), gives you an extension of time for making payments, or lets you temporarily make smaller payments than previously scheduled. Interest is charged during a forbearance on all types of Direct Loans.  The William D. Ford Federal Direct Loan (Direct Loan) Program includes Federal Direct Stafford/Ford (Direct Subsidized) Loans, Federal Direct Unsubsidized Stafford/Ford (Direct Unsubsidized) Loans, Federal Direct PLUS (Direct PLUS) Loans, and Federal Direct Consolidation (Direct Consolidation) Loans. These loans are known collectively as “Direct Loans”.
SECTION 7: ELIGIBILITY REQUIREMENTS
NOTE: To qualify for any of the deferments listed in Section 2 of this form, at the time you received your first Direct Loan, you must have had an outstanding balance on a FFEL Program loan that was made before July 1, 1993. Direct PLUS Loan and Direct PLUS Consolidation Loan borrowers are not eligible for the NOAA deferment.  You may defer repayment of your loan(s) while you are:  On active duty in the ARMED FORCES of the United States. You may receive this deferment for a maximum of 36 months. This is a combined limit with Public Health Service and NOAA deferments. To qualify, you must be on active duty in the Army, Navy, Air Force, Marine Corps or Coast Guard. Note: (1) If you are enlisted in a reserve component of the Armed Forces or the National Guard (while on active duty status in the Army or Air Force Reserves), you may qualify for this deferment only if you are: (a) serving full-time for a period expected to last at least one year, or (b) serving under an order for national mobilization. (2) As an alternative to having your commanding or personnel officer complete Section 4 of this form, you may provide the Direct Loan Servicing Center with copies of your military identification and orders.  Serving full-time as an officer in the Commissioned Corps of the PUBLIC HEALTH SERVICE. You may receive this deferment for a maximum of 36 months. This is a combined limit with Armed Forces and NOAA deferments.  Serving in the PEACE CORPS. You may receive this deferment for a maximum of 36 months. To qualify, you must have agreed to serve for a period of at least one year. NOTE: As an alternative to having an authorized Peace Corps official complete Section 4 of this form, you may provide the Direct Loan Servicing Center with documentation of the beginning and expected ending dates of your service in the Peace Corps. This documentation must be signed and dated by an authorized Peace Corps official.  A full-time paid volunteer in the ACTION PROGRAMS. You may receive this deferment for a maximum of 36 months. To qualify, you must have agreed to serve for a period of at least one year.  A full-time paid volunteer for a TAX-EXEMPT ORGANIZATION. You may receive this deferment for a maximum of 36 months. To qualify, you must: (1) be serving full-time in an organization that has a tax exemption under Section 501(c)(3) of the Internal Revenue Code of 1986; (2) assist low income people and their communities in eliminating poverty and poverty-related human, social, and environmental conditions; (3) not earn more than the federal minimum wage; however, you may receive fringe benefits like those received by other employees of the organization; (4) not engage in religious instruction, proselytizing, fund-raising to support religious activities, or conduct worship services as part of your duties; and (5) have agreed to serve for a period of at least one year.  On active duty in the NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION (NOAA). You may receive this deferment for a maximum of 36 months. This is a combined limit with Armed Forces and Public Health Service deferments.

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 §451 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1087a 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 William D. Ford Federal Direct Loan (Direct Loan) 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 Direct Loan 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 1845-0011. 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 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. Do not send the completed form to this address.

If you have questions about the status of your individual submission of this form, contact the Direct Loan Servicing Center (see Section 5).

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