Internship/Residency, National Guard Duty, DOD Loan Repa

MANDATORY FORBEARANCE REQUEST

SERV

Medical or Dental Internship/Residency, National Guard Duty, or Department
of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
DRAFT FORM
Exp. Date x/xx/xxxx

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 INFORMATION
Please enter or correct the following information.
Check this box if any of your information has changed.
SSN
Name
Address
State

City

Zip Code

Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: BORROWER DETERMINATION OF FORBEARANCE ELIGIBILITY
Carefully read the entire form before completing it. Complete the applicable part of Section 2 in its entirety. This form
covers three different types of forbearance. Review the information for each forbearance type to determine whether you
qualify for that forbearance.
PART A. MEDICAL OR DENTAL INTERNSHIP/RESIDENCY
You only qualify for this forbearance if you do not qualify
for a medical or dental internship/residency deferment.
1. Have you been accepted into an internship/residency?
Yes - Continue to Item 2.
No - You are not eligible for this forbearance.
2. Did your program require for admission that you have
a bachelor's degree?
Yes - Continue to Item 3.
No - You are not eligible for this forbearance.

5. Is completion of all or a portion of the program
required before you can begin professional practice or
service?
Yes - Complete Section 3 and have an authorized
official complete Section 4. In addition, you must
attach a separate statement from the appropriate
state licensing agency certifying this requirement.
No - You are not eligible for this forbearance.
PART B. NATIONAL GUARD DUTY
You only qualify for this forbearance if you do not qualify
for a military service deferment.
6. Are you a member of the National Guard?
Yes - Continue to Item 7.
No - You are not eligible for this forbearance.

3. Will you receive supervised training in your
internship/residency program?

7. Are you engaged in active state duty for a period of
more than 30 consecutive days because a governor
activated you based on state statute or policy?

Yes - Continue to Item 4.
No - You are not eligible for this forbearance.
4. Will completion of your program lead to a degree or
certificate awarded by an institution of higher
education, a hospital, or a health care facility that
offers postgraduate training?
Yes - Complete Section 3 and have an authorized
official complete Section 4.
No - Continue to Item 5.

Yes - Continue to Item 8.
No - Skip to Item 9.
8. Is your service being paid for with state funds?

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Yes - Skip to Item 11.
No - Continue to Item 9.

Borrower Name

Borrower SSN

SECTION 2: BORROWER DETERMINATION OF FORBEARANCE ELIGIBILITY (CONTINUED)
PART C. DEPARTMENT OF DEFENSE STUDENT LOAN
REPAYMENT PROGRAM
12. Are you performing service that qualifies you for a
partial repayment of your loans under any
Department of Defense Student Loan Repayment
Program?

9. Are you engaged in active state duty for a period of
more than 30 consecutive days under which a
governor activated you with the approval of the
President or the U.S. Secretary of Defense?
Yes - Continue to Item 10.
No - You are not eligible for this forbearance.

Yes - Complete Section 3 and have an authorized
official from the Department of Defense
complete Section 4.
No - You are not eligible for this forbearance.

10. Is your service being paid for with federal funds?
Yes - Continue to Item 11.
No - You are not eligible for this forbearance.
11. Were you activated no more than 6 months after the
last date on which you were enrolled in school at least
half-time?
Yes - Complete Section 3 and have an authorized
official (a commanding or personnel officer)
complete Section 4.
No - You are not eligible for this forbearance.

SECTION 3: BORROWER REQUESTS, UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION
I request:
• My loan holder grant forbearance for the period during which I meet the qualifications for the forbearance. If
approved for a forbearance, I would like to:
Temporarily stop making payments; or
Make smaller payments in the amount of

per month.

• My loan holder grant my forbearance for up to 12 months unless I specify an earlier end date:
If checked, to make interest payments on my loans during forbearance.
•

.

I understand:
• I am not required to make payments of loan principal or interest during forbearance.
• My forbearance will begin on the date the program or service that qualifies me for forbearance began, as certified by
the authorized official.
• My loan holder may grant me an additional forbearance while processing my form or to cover any period of
delinquency that exists when I submit my form.
• My forbearance will end on the earlier of the date I am no longer eligible for the forbearance, 12 months from the
start date of the forbearance, or the end date I requested.
• My forbearance will only be granted in increments of up to 12 months, and I must reapply for the forbearance if I
continue to meet the eligibility requirements and want to extend my forbearance.
• Interest may capitalize on my loans during or at the expiration of my forbearance.

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Borrower Name

Borrower SSN

SECTION 3: BORROWER REQUESTS, UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION (CONTINUED)
I certify that:
• The information I have provided on this form is true and correct.
• I will provide additional documentation to my loan holder, as required, to support my forbearance eligibility.
• I will notify my loan holder immediately when my eligibility for the forbearance ends.
• I have read, understand, and meet the eligibility requirements in Section 2.
I authorize the entity to which I submit this request and its agents to contact me regarding my request or my loans at any
cellular telephone number that I provide now or in the future using automated telephone dialing equipment or artificial
prerecorded voice or text messages.
Date

Borrower's Signature
SECTION 4: AUTHORIZED OFFICIAL'S CERTIFICATION

Do not complete this section unless the borrower has completed the applicable part of Section 2 in its entirety. Note:
Instead of having an authorized official complete this section, you may attach separate documentation from an authorized
official that includes all of the information requested below and a certification that you and the program meet all conditions
indicated by your responses in Section 2. For the National Guard Duty forbearance, you may attach a copy of your orders.
• The program/service begins/began on:

• The program/service is expected to end/ended on:

I certify, to the best of my knowledge and belief, that:
• The borrower named above is/was engaged in the program/service indicated in Section 2;
• The borrower and program/service meet all conditions indicated by the borrower's responses in Section 2; and
• The information that I have provided in this section is accurate.
Name of Institution/Organization
City

Address
Official's Name/Title

State

Zip Code

Telephone
Date

Official's Signature
SECTION 5: INSTRUCTIONS FOR COMPLETING THE FORM

Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Example: March 14, 2019 = 03-14-2019. Include
your name and account number on any documentation that you submit with this form. If you want to apply for a forbearance
on loans that are held by different loan holders, you must submit a separate forbearance request to each loan holder. Return
the completed form and any required documentation to the address shown in Section 7.
Endorsers may request forbearance only when you are required to repay the loan because the borrower is not making
payments. For those who have loans made jointly (as co-makers), both borrowers must individually meet the requirements
for a forbearance and each of you must submit a separate forbearance request.

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SECTION 6: DEFINITIONS
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.
The Federal Family Education Loan (FFEL) Program
includes Federal Stafford Loans, Federal PLUS Loans,
Federal Consolidation Loans, and Federal Supplemental
Loans for Students (SLS).
An authorized official for the medical or dental
internship/residency forbearance is an official from your
internship/residency program. An authorized official for
the National Guard State Duty forbearance is your
commanding or personnel officer. An authorized official
for the Department of Defense Student Loan Repayment
Program forbearance is an official from the Department of
Defense.
Capitalization is the addition of unpaid interest to the
principal balance of your loan. Capitalization causes more
interest to accrue over the life of the loan and may cause
your monthly payment amount to increase. Table 1
(below) provides an example of the monthly payments
and the total amount repaid for a $30,000 unsubsidized
loan. The example loan has a 6% interest rate and the
example deferment or forbearance lasts for 12 months
and begins when the loan entered repayment. The
example compares the effects of paying the interest as it
accrues or allowing it to capitalize.
A co-maker is one of the two individual who are joint
borrowers on a Direct or Federal Consolidation Loan or a
Federal PLUS Loan. Both co-makers are equally
responsible for repaying the full amount of the loan.

Interest is capitalized at the
end
Interest is capitalized
quarterly and at the end

A deferment is a period during which you are entitled
to postpone repayment of your loans. Interest is not
generally charged to you during a deferment on your
subsidized loans. Interest is always charged to you during
a deferment on your unsubsidized loans.
A forbearance is a period during which you are
allowed to postpone making payments temporarily,
allowed an extension of time for making payments, or
temporarily allowed to make smaller payments than
scheduled. A forbearance can be a mandatory
forbearance, meaning that your loan holder must grant
the forbearance if you qualify for the forbearance and
supply all supporting documentation. A forbearance can
also be a discretionary forbearance, meaning that your
loan holder may grant the forbearance, but is not required
to do so.
The holder of your Direct Loan Program loans is the
Department. The holder of your FFEL Program loans may
be a lender, guaranty agency, secondary market, or the
Department. Your loan holder may use a servicer to
handle billing and other communications related to your
loans. References to “your loan holder” on this form mean
either your loan holder or your servicer.
A subsidized loan is a Direct Subsidized Loan, a Direct
Subsidized Consolidation Loan, a Federal Subsidized
Stafford Loan, and portions of some Federal Consolidation
Loans.
An unsubsidized loan is a Direct Unsubsidized Loan, a
Direct Unsubsidized Consolidation Loan, a Direct PLUS
Loan, a Federal Unsubsidized Stafford Loan, a Federal
PLUS Loan, a Federal SLS, and portions of some Federal
Consolidation Loans.

Table 1. Capitalization Chart
Treatment of Interest with
Loan Amount
Deferment/Forbearance
Interest is paid
$30,000

An endorser is an individual who sings a promissory
note and agrees to pay the loan if teh borrower sdoes not.

Capitalized
Interest

Outstanding
Principal

Monthly
Payment

Number of
Total Repaid
Payments

$0

$30,000

$333

120

$41,767

$30,000

$1,800

$31,800

$353

120

$42,365

$30,000

$1,841

$31,841

$354

120

$42,420

SECTION 7: WHERE TO SEND THE COMPLETED FORBEARANCE REQUEST
Return the completed form and any documentation to:
(If no address is shown, return to your loan holder.)

If you need help completing this form, call:
(If no phone 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 authorities for collecting the requested
information from and about you are §421 et seq. or §451 et
seq. of the Higher Education Act of 1965, as amended (20
U.S.C. 1071 et seq. or 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 William D. Ford Federal Direct Loan
(Direct Loan) Program or Federal Family Education Loan
(FFEL) 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 or FFEL
Programs, to permit the servicing of your loans, and, if it
becomes necessary, to locate you and to collect and report
on your loans if your loans become delinquent or 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 loans, to enforce the
terms of the loans, 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 such
collection displays a valid OMB control number. The valid
OMB control number for this information collection is
1845-0018. Public reporting burden for this collection of
information is estimated to average 15 minutes per
response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the
collection of information. The obligation to respond to this
collection is required to obtain a benefit in accordance with
34 CFR 682.211 or 685.205.
If you have comments or concerns regarding the
status of your individual submission of this form, please
contact your loan holder directly (see Section 7).

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