Direct Loan Program Education Related Deferment Request

OMB No. 1845-0011

Draft Form

Exp. Date XX/XX/XX

E DU

EDUCATION RELATED DEFERMENT REQUEST

William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family Education Loan (FFEL) Program

WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying document 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.

Check this box if any of your information has changed.

SSN

-

-

Name

Address

City, State, Zip Code

Telephone – Primary ( )

Telephone – Alternate ( )

E-mail Address (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.

 I meet the eligibility requirements stated in Section 7 for the deferment checked below and request that my loan holder defer repayment of my loan(s) while I am:

• For all borrowers:

In a full-time course of study in a GRADUATE FELLOWSHIP program.

In a full-time REHABILITATION TRAINING program.

• For some borrowers whose FFEL Program loans were first disbursed before July 1, 1993 (see Section 7):

In an INTERNSHIP/RESIDENCY training program that leads to a degree or certificate awarded by an institution of higher education, a hospital, or a health care facility.

In an INTERNSHIP/RESIDENCY program at an institution or organization that is required to begin professional practice or service.

Teaching in a designated TEACHER SHORTAGE AREA.

SECTION 3: BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION

 I understand that:

(1) I am not required to make payments of loan principal during my deferment. Interest will not accrue on my subsidized loan(s) during my deferment. However, interest will accrue on my unsubsidized loan(s).

(2) I may pay the interest that accrues on my unsubsidized loan(s) during my deferment. 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 on my unsubsidized loan(s).

I wish to make interest payments on my unsubsidized loan(s) during my deferment.

(3) My deferment will begin on the date the program or teaching service that qualifies me for the deferment began, as certified by the authorized official.

(4) My deferment will end on the earlier of the date that I am no longer in the program or teaching service, or the ending date as certified by the authorized official.

(5) If my deferment does not cover all my past due payments, my loan holder may grant a forbearance on my loan(s) for all payments due before the begin date of my deferment. If the period for which I am eligible for a deferment has ended, my loan holder may grant a forbearance on my loan(s) for all payments due when my deferment request is processed. Interest that accrues during this forbearance may be capitalized.

(6) My loan holder may grant a forbearance on my loan(s) 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.

 I certify that: (1) The information I have provided on this form is true and correct. (2) I will provide additional documentation to my loan holder, as required, to support my deferment status. (3) I will notify my loan holder immediately when the program or teaching service that qualified me for the deferment ends. (4) I have read, understand, and meet the eligibility requirements of the deferment for which I have applied, as explained in Section 7.

 I authorize the entity to which I submit this request (i.e., the school, the lender, the guaranty agency, the U.S. Department of Education, and their respective agents and contractors) to contact me regarding my request or my loan(s), including repayment of my loan(s), at the number that I provide on this form or any future number that I provide for my cellular telephone or other wireless device using automated telephone dialing equipment or artificial or prerecorded voice or text messages.

Borrower’s Signature

Date

SECTION 4: AUTHORIZED OFFICIAL’S CERTIFICATION

Note: As an alternative to completing this section, you may attach separate documentation from an authorized official that includes all of the information requested below.

I certify, to the best of my knowledge and belief, that the borrower named above is/was in the program/teaching service indicated in Section 2, and that the borrower and the program/teaching service meet all of the eligibility requirements stated in Section 7.

The program/teaching service begins/began on |____|____|-|____|____|-|____|____|____|____| and is expected to end/ended on |____|____|-|____|____|-|____|____|____|____|.

Teacher Shortage Area Deferment Only: The borrower is/was teaching in (area/curriculum) _____________________________________, which is a shortage area designated by

the U.S. Secretary of Education for the state of ______ for the school year beginning on |____|____|-|____|____|-|____|____|____|____|

and ending on |____|____|-|____|____|-|____|____|____|____|. The borrower is/was teaching grade level __________.

Internship/Residency Deferment Only: Name of Internship/Residency program __________________________________________________________________________.

Name of Institution					OPE-ID (if applicable)
Address					City, State, Zip Code
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 31, 2012 = 01-31-2012. An authorized official must either complete Section 4 or attach the organization’s own signed certification listing the required information. Include your name and account number on any documentation that you are required to submit with this form. If you need help completing this form, contact your loan holder. If you want to apply for a deferment on 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

 An authorized official who may complete Section 4 is either: (1) an official of the Graduate Fellowship Program, Rehabilitation Training Program, or Internship/Residency Program; or (2) the Chief School Administrator (if you are teaching in teacher shortage areas, additional certification may be required if the Chief State School Officer has not provided a list of approved shortage areas to school administrators).

 Capitalization is the addition of unpaid interest to the principal balance of your loan. The principal balance of a loan increases when payments are postponed during periods of deferment or forbearance and unpaid interest is capitalized. As a result, more interest may accrue over the life of the loan, the monthly payment amount may be higher, or more payments may be required. The chart below provides estimates, for a $15,000 unsubsidized loan balance at a 6.8% interest rate, of the monthly payments due following a 12-month deferment that started when the loan entered repayment. It compares the effects of paying the interest as it accrues, capitalizing the interest at the end of the deferment, and capitalizing interest quarterly and at the end of the deferment. Please note that the U.S. Department of Education (the Department) and many other holders do not capitalize interest on a quarterly basis. The actual loan interest cost will depend on your interest rate, length of the deferment, and frequency of capitalization. Paying interest during the period of deferment lowers the monthly payment by about $12 and saves about $426 over the lifetime of the loan, as depicted in the chart below.

Treatment of Interest Accrued During Deferment	Loan Amount	Capitalized Interest for 12 Months	Principal to Be Repaid	Monthly Payment	Number of Payments	Total Amount Repaid	Total Interest Paid
Interest is paid	$15,000.00	$0.00	$15,000.00	$172.62	120	$21,736.55*	$6,730.66
Interest is capitalized at the end of deferment	$15,000.00	$1,022.09	$16,022.09	$184.38	120	$22,125.94	$7,119.64
Interest is capitalized quarterly during deferment and at the end of deferment	$15,000.00	$1,048.51	$16,048.51	$184.69	120	$22,162.41	$7,156.10

*Total amount repaid includes $1,022.09 of interest paid during the 12-month period of deferment.

 A deferment is a period during which you are entitled to postpone repayment of the principal balance of your loan(s). Interest does not accrue during a deferment on a Direct Subsidized Loan, a Direct Subsidized Consolidation Loan, a subsidized Federal Stafford Loan, or, in some cases, the subsidized portion of a Federal Consolidation Loan (see Note). Interest does accrue during a deferment on a Direct Unsubsidized Loan, a Direct PLUS Loan, a Direct Unsubsidized Consolidation Loan, an unsubsidized Federal Stafford Loan, a Federal PLUS Loan, or a Federal SLS Loan. Note: Interest does not accrue on a Federal Consolidation Loan during a deferment only if: (1) the application for the Federal Consolidation Loan was received by your loan holder on or after January 1, 1993, but before August 10, 1993; (2) the application was received by your loan holder on or after August 10, 1993, and the Federal Consolidation Loan includes only Federal Stafford Loans that were eligible for federal interest subsidy; or (3) the application was received by your loan holder on or after November 13, 1997, in which case interest does not accrue on the portion of the Federal Consolidation Loan that paid a subsidized Direct Loan or FFEL Program loan(s).

 The Federal Family Education Loan (FFEL) Program includes Federal Stafford Loans, Federal PLUS Loans, Federal Consolidation Loans, and Federal Supplemental Loans for Students (SLS).

 A forbearance is a period during which you are permitted to temporarily postpone making payments, allowed an extension of time for making payments, or temporarily allowed to make smaller payments than scheduled.

 The holder of your Direct Loan Program loan(s) is the Department. The holder of your FFEL Program loan(s) may be a lender, guaranty agency, secondary market, or the Department.

 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.

SECTION 7: ELIGIBILITY REQUIREMENTS

GRADUATE FELLOWSHIP

 You may defer repayment of your loan(s) while you are in a full-time course of study in a Graduate Fellowship Program. To qualify, your graduate fellowship program must: (1) provide sufficient financial support to allow for full-time study for a period of at least 6 months; (2) require, before the awarding of financial support, a written statement from each applicant which explains the applicant’s objectives; (3) require a graduate fellow to submit periodic reports, projects, or other evidence of the graduate fellow’s progress; and (4) in the case of a course of study at a foreign university, accept the course of study for completion of the fellowship program. In addition, you must: (1) hold at least a Bachelor’s Degree conferred by an institution of higher education; and (2) have been accepted or recommended by an institution of higher education for acceptance into the graduate fellowship program on a full-time basis.

REHABILITATION TRAINING

 You may defer repayment of your loan(s) while you are in a full-time Rehabilitation Training Program. To qualify, your training program must: (1) be licensed, approved, certified, or recognized as providing rehabilitation training to disabled individuals by the Department of Veterans Affairs or a state agency responsible for vocational rehabilitation, drug abuse treatment, mental health services, or alcohol abuse treatment programs; (2) provide services under a written individualized plan that specifies the date the services are expected to end; and (3) be structured in a way that requires a substantial commitment by you to your rehabilitation. (“Substantial commitment” means a commitment of time and effort that would normally prevent a person from being employed 30 or more hours per week in a position expected to last at least 3 months.) In addition, you must be either receiving, or scheduled to receive, these rehabilitation services.

INTERNSHIP/RESIDENCY

• To qualify:

• For Direct Loan Program borrowers: You must have had an outstanding balance on a FFEL Program loan that was first disbursed before July 1, 1993 when you obtained your first Direct Loan.

• For FFEL Program borrowers: You must have an outstanding balance on a FFEL Program loan that was first disbursed before July 1, 1993, or had a balance on a FFEL Program loan that was first disbursed before July 1, 1993 when you obtained a loan on or after July 1, 1993. Federal PLUS Loans are eligible for this deferment only if they were first disbursed before August 15, 1983. Federal Consolidation Loans are not eligible for this deferment.

 You may defer repayment of your loan(s) while you are in an Internship/Residency Program. Maximum eligibility is 24 months. If your loan(s) was first disbursed after July 1, 1993, or if you have exhausted the 24 months of deferment, you may request forbearance for the remainder of your medical or dental Internship/Residency Program. Dental Interns/Residents are encouraged to apply for an In-School Deferment. To qualify, you must have been accepted into an Internship/Residency Program which must: (1) be a supervised training program; and (2) require that you hold at least a Bachelor’s Degree before acceptance into the program. In addition, completion of your program must either: (1) lead to a degree or certificate awarded by an institution of higher education, a hospital, or a health care facility that offers postgraduate training; or (2) be required before you can begin professional practice or service. If completion of the program is required before you may begin professional practice or service and the program does not lead to a degree or certificate awarded by an institution of higher education, a hospital, or a health care facility that offers postgraduate training, you must attach a separate statement from the appropriate state licensing agency certifying this requirement in addition to the certification from an authorized official of your program in Section 4.

SECTION 7 CONTINUES ON PAGE 3

SECTION 7: ELIGIBILITY REQUIREMENTS (CONTINUED)

TEACHER SHORTAGE AREA

• To qualify:

• For Direct Loan Program borrowers: You must have had an outstanding balance on a FFEL Program loan that was first disbursed before July 1, 1993 when you obtained your first Direct Loan. Direct PLUS and Direct PLUS Consolidation Loans are not eligible for this deferment.

• For FFEL Program borrowers: You must be a Federal Stafford or SLS Loan borrower whose first FFEL Program loan was first disbursed on or after July 1, 1987 and before July 1, 1993 or had a balance on a FFEL Program loan that was first disbursed on or after July 1, 1987 and before July 1, 1993 when you obtained a loan on or after July 1, 1993. Federal PLUS Loans are not eligible for this deferment.

 You may defer repayment of your loan(s) while you are teaching in a designated teacher shortage area. Maximum eligibility is 36 months. To qualify, you must teach full time in a public or non-profit private elementary or secondary school in a geographic region or specific grade level, academic, instructional, subject matter, or discipline classification that has been designated as a shortage area by the U.S. Department of Education. (You may contact your Chief School Administrator or Chief State School Officer for a list of your state’s shortage areas.) You may reapply for a continuation of this deferment even if your teaching area is no longer classified as a shortage area.

SECTION 8: WHERE TO SEND THE COMPLETED DEFERMENT REQUEST

Return the completed form 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 authorities for collecting the requested information from and about you are §421 et seq. and §451 et seq. of the Higher Education Act of 1965, as amended (20 U.S.C. 1071 et seq. and 20 U.S.C. 1087a et seq.) and the authorities for collecting and using your Social Security Number (SSN) are §§428B(f) and 484(a)(4) of the HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31 U.S.C. 7701(b). Participating in the Federal Family Education Loan (FFEL) Program or 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 FFEL and/or Direct Loan Programs, 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 defaults. 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 statuses, 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. Public reporting burden for this collection of information is estimated to average 0.25ated to average 0.16 hours (10 hours (15 minutes) per response, including the time for reviewing instructions, searching existing data resources, gathering and maintaining the data needed, and completing and reviewing the information collection. Individuals are obligated to respond to this collection to obtain a benefit in accordance with 34 CFR 682.210 or 685.204. Send comments regarding the burden estimate(s) or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Education, 400 Maryland Avenue, SW, Washington, DC 20210-4537 or e-mail [email protected] and reference OMB Control Number 1845-0011. Note: Please do not return the completed form to this address.

If you have questions regarding the status of your individual submission of this form, contact your loan holder (see Section 8).

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