Form 1845-0059 Teacher Loan Forgiveness Application

OMB No. 1845-0059
Form Under Review
Exp. Date xx/xx/xxxx

TEACHER LOAN FORGIVENESS APPLICATION
William D. Ford Federal Direct Loan (Direct Loan) Program
Federal Family Education Loan (FFEL) Program

TLFA

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
State

City

Zip Code

Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: LOAN FORGIVENESS REQUEST (TO BE COMPLETED BY THE BORROWER)
READ SECTIONS 7 - 10 BEFORE COMPLETING THE APPLICATION. The information you provide may be subject to
verification.
I request forgiveness on my Direct Loan and/or FFEL program loans based on my employment as a full-time teacher for at
least five consecutive, complete academic years. During that five-year period, I taught (check all that apply):
at an eligible elementary school

at an eligible secondary school

for an eligible educational service agency

AND I was (check all that apply):
A highly qualified full-time special education teacher for elementary school children with disabilities (forgiveness of up to
$17,500).
A highly qualified full-time special education teacher for secondary school children with disabilities (forgiveness of up to
$17,500).
A highly qualified full-time mathematics teacher for secondary school students (forgiveness of up to $17,500).
A highly qualified full-time science teacher for secondary school students (forgiveness of up to $17,500).
A highly qualified full-time secondary education teacher, or (only if my teaching service began before 10/30/2004) a fulltime secondary education teacher in a subject area relevant to my academic major (forgiveness of up to $5,000).
A highly qualified full-time elementary education teacher, or (only if my teaching service began before 10/30/2004) a fulltime elementary education teacher and I demonstrated knowledge and teaching skills in reading, writing, mathematics,
and other areas of the elementary school curriculum (forgiveness of up to $5,000).

Page 1 of 8

Borrower Name

Borrower SSN

SECTION 3: PREVIOUS LOAN FORGIVENESS INFORMATION (TO BE COMPLETED BY THE BORROWER)
Have you previously applied for or received loan forgiveness from a loan holder or servicer other than the loan holder/
servicer to which you are submitting this application for Teacher Loan Forgiveness?
No - Skip to Section 4.
Yes - Check the appropriate box below and provide the requested information.
I applied for loan forgiveness with the loan holder/servicer listed below, but have not yet received forgiveness.
Provide the loan holder/servicer information requested below; leave "Forgiveness Amount" blank.
I applied for and received loan forgiveness with the loan holder/servicer listed below. Provide the loan holder/servicer
and forgiveness amount information requested below.
Loan Holder Name
Telephone or Web Site
Forgiveness Amount $
SECTION 4: UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION (TO BE COMPLETED BY THE BORROWER)
I understand that: (1) my loan holder will apply a forbearance of principal and interest on my qualifying loans from the date
my loan holder receives my completed loan forgiveness application through the date my loan forgiveness request is
approved or denied, unless I notify my loan holder that I want to continue making regular payments during this period; (2) if I
continue making regular payments while my application is being reviewed, this may reduce the amount of my loan
forgiveness; (3) if I am past due on payments when this application is processed, my loan holder may grant a separate
forbearance to resolve the delinquency; and (4) unpaid interest that accrues during each of these forbearance periods will
not be capitalized on a Direct Loan Program loan, but it may be capitalized on a FFEL Program loan.
I certify that: (1) the information I provided in Sections 1-3 is true and correct; and (2) I have read and understand the
definitions and terms and conditions in Sections 8-10, and I meet the eligibility requirements for loan forgiveness.
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 or
prerecorded voice or text messages.
Date

Borrower's Signature

SECTION 5: CHIEF ADMINISTRATIVE OFFICER'S (CAO'S) CERTIFICATION (TO BE COMPLETED BY THE CAO)
Carefully read Sections 7-10. Return the completed form to the applicant identified in Section 1.
I certify, to the best of my knowledge and belief, that: (1) the applicant has met the requirements for loan forgiveness as
specified in Sections 8-10, and (2) during the period for which the applicant is seeking forgiveness, the applicant was a
teacher as defined in Sections 8 and 9 and taught full time for one or more consecutive, complete academic years at one or
more eligible Title I schools or educational service agencies (ESAs) in the capacity that the applicant indicated in Section 2
from (mm-dd-yyyy)
to
School (not school district) or ESA Name
Check here if this is a school operated by the Bureau of Indian Education (BIE) or operated on an Indian reservation by
an Indian tribal group under contract with the BIE.
School or ESA Address (Street, City, State, Zip Code)
School or ESA Website
School District

County

CAO's Name and Title (Printed)
Date

CAO's Signature
Telephone

Email (Optional)
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SECTION 6: WHERE TO SEND THE COMPLETED LOAN FORGIVENESS APPLICATION
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 information is shown, call your loan holder.)

SECTION 7: INSTRUCTIONS FOR COMPLETING THE APPLICATION
Throughout this application, all references to “the Department” mean the U.S. Department of Education.
Before completing Sections 2-4, carefully read the entire application. Be sure to provide all requested information. Enter your
name and Social Security Number at the top of page 2. Type or print using dark ink. Show dates as mm-dd-yyyy (for example,
show “January 31, 2024” as “01-31-2024”).
The chief administrative officer (CAO) of the school or educational service agency where you performed your
qualifying teaching service must complete Section 5.
If you taught at more than one school or for more than one educational service agency (ESA) during the same academic year
or during different academic years, a single CAO who has access to employment records that establish your eligibility for loan
forgiveness and is authorized to verify your qualifying employment at each school/ESA may complete Section 5. However, all
of the schools/ESAs must be listed. Otherwise, the CAOs from each school/ESA must certify your eligibility. If you need to list
multiple schools/ESAs or need more than one CAO's certification, the information required in Section 5 may be provided on a
separate piece of paper and submitted with your completed form.
Return the completed application to the address shown in Section 6. If you are applying for forgiveness of loans that are
held by different loan holders, you must submit a separate application to each loan holder.
SECTION 8: DEFINITIONS
A teacher is a person who provides direct classroom
teaching or classroom-type teaching in a non-classroom
setting, including special education teachers (see below).
NOTE: School librarians, guidance counselors, and other
administrative staff are not considered teachers for the
purposes of this loan forgiveness program.
Special education means specially designed
instruction, at no cost to parents, to meet the unique needs
of a child with a disability (see below), including instruction
conducted in the classroom, in the home, in hospitals and
institutions, and in other settings; and instruction in physical
education (see below).
A child with a disability is a child who needs special
education and related services because the child has an
intellectual disability, a hearing impairment (including
deafness), a speech or language impairment, a visual
impairment (including blindness), a serious emotional
disturbance, an orthopedic impairment, autism, a traumatic
brain injury, another health impairment, or a specific
learning disability. For a child age 3 through 9, the term “a
child with a disability” may, at the discretion of the state and
the local educational agency, include a child who needs
special education and related services because the child is
experiencing developmental delays, as defined by the state
and as measured by appropriate diagnostic instruments

and procedures, in one or more of the following areas:
physical development, cognitive development,
communication development, social or emotional
development, or adaptive development.
Physical education means the development of physical
and motor fitness, fundamental motor skills and patterns,
and skills in aquatics, dance, and individual and group
games and sports (including intramural and lifetime sports),
and includes special physical education, adapted physical
education, movement education, and motor development.
An elementary school is a public or nonprofit private
school that provides elementary education as determined
by state law or, if the school is not in a state, by the
Department.
A secondary school is a public or nonprofit private
school that provides secondary education as determined by
state law or, if the school is not in a state, by the
Department.
An educational service agency is a regional public
multiservice agency (not a private organization) authorized
by state statute to develop, manage, and provide services or
programs to local educational agencies (such as public
school districts), as defined in section 9101 of the
Elementary and Secondary Education Act of 1965, as
amended.

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SECTION 8: DEFINITIONS (CONTINUED)
An academic year is:
• One complete school year at the same school or for
the same educational service agency, or
• Two complete and consecutive half years at
different schools or for different educational service
agencies, or
• Two complete and consecutive half years from
different school years at either the same school or
for the same educational service agency or at
different schools or for different educational service
agencies.
Half years do not include summer sessions. Two half
years generally fall within a 12-month period. For schools or
educational service agencies that have a year-round
program of instruction, a minimum of nine months is
considered an academic year.
Full time means the standard used by a state in
defining full-time employment as a teacher. If you teach in
more than one school or educational service agency, full
time is based on the combination of all of your qualifying
employment.
Loans that are eligible for forgiveness are:
• Federal Direct Stafford/Ford Loans (Direct
Subsidized Loans);
• Federal Direct Unsubsidized Stafford/Ford Loans
(Direct Unsubsidized Loans);
• Subsidized Federal Stafford Loans;
• Unsubsidized Federal Stafford Loans; and
• Any portion of a Federal Direct Consolidation Loan
or Federal Consolidation Loan that paid off an
eligible Direct Subsidized Loan, Direct Unsubsidized
Loan, Subsidized Federal Stafford Loan, or
Unsubsidized Federal Stafford Loan.

Direct PLUS Loans, Federal PLUS Loans, and any portion
of a Direct Consolidation Loan or Federal Consolidation
Loan that paid off a PLUS loan are not eligible for
forgiveness.
The holder of your Direct Loan Program loans is the
Department. The holder of your FFEL Program loans may be
a lender, secondary market, guaranty agency, 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.
The chief administrative officer (CAO)is the official
who has access to employment records that establish your
eligibility for loan forgiveness in accordance with the
requirements explained on this form, and who is authorized
to verify your qualifying employment at a school or by an
educational service agency. Depending on your employer,
the CAO may be a superintendent, a human resources
official or other school district or educational service agency
official, or a principal or assistant principal.
A forbearance is a period of time during which you are
temporarily not required to make payments or temporarily
allowed to make smaller payments than previously
scheduled, or an extension of time for making payments.
You are responsible for any interest that accrues on a loan
during forbearance.
Interest that accrues on a Direct Loan Program loan
during forbearance will not be capitalized. However, if you
do not pay the interest that accrues on a FFEL Program loan
during forbearance, the interest may be capitalized.
Capitalization is the addition of unpaid interest to the
principal balance of your loan. This will increase the
principal and total cost of your loan.

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SECTION 9: DEFINITION OF HIGHLY QUALIFIED
PUBLIC SCHOOL TEACHERS
To be a highly qualified teacher, a teacher of public
elementary or secondary school students or a teacher
employed by an educational service agency must:

A teacher of elementary, middle, or secondary
school students who is not new to the profession also is
considered highly qualified if the teacher holds at least a
bachelor's degree and:

• Have obtained full state certification as a teacher
(including certification obtained through alternative
routes to certification) or passed the state teacher
licensing examination, and hold a license to teach in
that state, except that when used with respect to
teaching in a public charter school, the term “highly
qualified teacher” means that the teacher meets the
requirements set forth in the state's public charter
school law; and

• Meets the applicable standards of a teacher of
elementary, middle, or secondary school students
who is new to the profession; or
• Demonstrates competence in all the academic
subjects in which the teacher teaches based on a
high objective, uniform state standard of evaluation
that: (1) is set by the state for both grade
appropriate academic subject matter knowledge
and teaching skills; (2) is aligned with challenging
state academic content and student academic
achievement standards and developed in
consultation with core content specialists, teachers,
principals, and school administrators; (3) provides
objective, coherent information about the teacher's
attainment of core content knowledge in the
academic subjects in which a teacher teaches; (4) is
applied uniformly to all teachers in the same
academic subject and the same grade level
throughout the state; (5) takes into consideration,
but is not based primarily on, the time the teacher
has been teaching in the academic subject; (6) is
made available to the public upon request; and (7)
may involve multiple, objective measures of teacher
competency.

• Not have had certification or licensure requirements
waived on an emergency, temporary, or provisional
basis.
In addition, a teacher of elementary school students
who is new to the profession also is considered highly
qualified if the teacher:
• Holds at least a bachelor's degree; and
• Has demonstrated, by passing a rigorous state test,
subject knowledge and teaching skills in reading,
writing, mathematics, and other areas of the basic
elementary school curriculum (which may consist of
passing a state-required certification or licensing
test or tests in reading, writing, mathematics, and
other areas of the basic elementary school
curriculum).
A teacher of middle or secondary school students
who is new to the profession also is considered highly
qualified if the teacher:
• Holds at least a bachelor's degree; and
• Has demonstrated a high level of competency in
each of the academic subjects in which the teacher
teaches by: (1) passing a rigorous state academic
subject test in each of the academic subjects in
which the teacher teaches (which may consist of a
passing level of performance on a state-required
certification or licensing test or tests in each of the
academic subjects in which the teacher teaches); or
(2) successful completion, in each of the academic
subjects in which the teacher teaches, of an
academic major, a graduate degree, coursework
equivalent to an undergraduate academic major, or
advanced certification or credentialing.

PRIVATE SCHOOL TEACHERS
To be a highly qualified teacher, a teacher in a private,
non-profit elementary or secondary school who is not a
highly qualified teacher as defined above must satisfy
rigorous subject knowledge and skills tests by taking
competency tests in applicable grade levels and subject
areas. The competency tests must be recognized by five or
more states for the purposes of fulfilling the highly qualified
teacher requirements under section 9101 of the Elementary
and Secondary Education Act of 1965. The teacher must also
achieve a score on each test that equals or exceeds the
average passing score for those states.

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SECTION 10: TERMS AND CONDITIONS
Under the Teacher Loan Forgiveness Program, if you
teach full time for five consecutive, complete academic
years at certain elementary and secondary schools or for
certain educational service agencies that serve low-income
families and meet other qualifications, you may be eligible
for forgiveness of up to a combined total of $5,000 or
$17,500 (as applicable) of principal and interest on your
Direct Loan and/or FFEL program loans.
To qualify for loan forgiveness, you must not have had
an outstanding balance on a Direct Loan or FFEL program
loan on October 1, 1998, or on the date that you obtained a
Direct Loan or FFEL program loan after October 1, 1998.
You are not eligible to receive forgiveness on a
defaulted loan unless you have first made satisfactory
repayment arrangements with the holder of the defaulted
loan.
Any loan for which you are seeking forgiveness must
have been made before the end of your five consecutive,
complete academic years of qualifying teaching service.
You may not receive benefits through the AmeriCorps
Program under Subtitle D of Title I of the National and
Community Service Act of 1990 or loan forgiveness under
the Direct Loan Public Service Loan Forgiveness Program for
the same period of teaching service for which you receive
forgiveness under this Teacher Loan Forgiveness Program.
You must have been employed as a full-time teacher for
five consecutive, complete academic years at an elementary
or secondary school or for an educational service agency
that is listed in the Annual Directory of Designated LowIncome Schools for Teacher Cancellation Benefits (TCLI
Directory). The TCLI Directory is available online at
studentaid.gov/app/tcli.action. If this directory is not
available before May 1 of any year, the previous year's
directory may be used. To qualify for inclusion in the TCLI
Directory, a school or educational service agency must: (1)
be in a school district that qualifies for funds under Title I of
the Elementary and Secondary Education Act of 1965, as
amended; and (2) have been selected by the Department
based on a determination that more than 30% of the
school's or educational service agency's total enrollment is
made up of children who qualify for services provided under
Title I.
All elementary and secondary schools operated by the
Bureau of Indian Education (BIE) or operated on Indian
reservations by Indian tribal groups under contract with the
BIE qualify as schools serving low-income students.

If your school or educational service agency is included
in the TCLI Directory for at least one qualifying year of your
teaching service, but does not qualify for inclusion in the
TCLI Directory during subsequent years, your subsequent
years of teaching at that school or educational service
agency may be counted toward the required five years of
teaching. Any years of teaching before the school or
educational service agency qualified for inclusion in the TCLI
Directory may not be counted.
If you were unable to complete a full academic year of
teaching, your absence from teaching for part of the year
(including the time needed for you to resume teaching no
later than the beginning of the next regularly scheduled
academic year) will not be considered a break in the
required five consecutive, complete academic years of
teaching if ALL of the following requirements are met:
• You completed at least one-half of the academic
year;
• You were unable to complete the remainder of the
academic year: (1) because you returned to
postsecondary education, on at least a half-time
basis, in an area of study directly related to the
performance of the teaching service described
above; (2) due to a circumstance that is a qualifying
reason for leave under the Family and Medical Leave
Act of 1993 (FMLA); or (3) because you were called
or ordered to active duty status for more than 30
days as a member of a reserve component of the
Armed Forces; and
• Your employer considers you to have fulfilled your
contract requirements for the academic year for the
purposes of salary increases, tenure, and retirement.
You may qualify for forgiveness based on qualifying
teaching service at any combination of eligible elementary
schools, secondary schools, or educational service agencies.
Teaching at an eligible elementary or secondary school
may be counted only if at least one of the five years of
teaching was after the 1997 -1998 academic year.
Teaching for an eligible educational service agency
may be counted only if the consecutive five-year period
includes qualifying service for an eligible educational
service agency performed after the 2007 -2008 academic
year.

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SECTION 10: TERMS AND CONDITIONS (CONTINUED)
You may receive up to $5,000 in loan forgiveness if you
were a highly qualified full-time teacher for elementary or
secondary school students or (only if your qualifying
teaching service began before October 30, 2004) you were
(1) a full-time teacher for elementary school students and
you demonstrated knowledge and teaching skills in
reading, writing, mathematics, and other areas of the
elementary school curriculum, or (2) a full-time teacher for
secondary school students and you taught in a subject area
that was relevant to your academic major.
You may receive up to $17,500 in loan forgiveness if
you were (1) a highly qualified full-time teacher of
mathematics or science to secondary school students; or (2)
a highly qualified full-time special education teacher whose
primary responsibility was to provide special education to
children with disabilities, and you taught children with
disabilities that corresponded to your area of special
education training and have demonstrated knowledge and
teaching skills in the content areas of the curriculum that
you taught.

You are not eligible for forgiveness of more than a
combined total of $5,000 or $17,500 (as applicable) of
principal and interest of your Direct Loan and/or FFEL
program loans. You must repay any loan balance that
remains after forgiveness has been granted.
Unless you instruct your loan holder otherwise, the
forgiveness amount will be applied to your loans in the
following order: (1) Direct Unsubsidized Loans or
unsubsidized Federal Stafford Loans, (2) Direct Subsidized
Loans or subsidized Federal Stafford Loans, and (3) Direct
Unsubsidized Consolidation Loans, Direct Subsidized
Consolidation Loans, or Federal Consolidation Loans.
If you are determined to be eligible for loan
forgiveness under this program, your loan holder will not
refund any payments that you made or that were made on
your behalf before the determination of eligibility.
If you receive loan forgiveness based on any false,
fictitious, or fraudulent statements that you make on this
form or on any accompanying documents, you may be
required to repay the amount forgiven and you may be
subject to civil and criminal penalties under applicable
federal law.

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SECTION 11: IMPORTANT NOTICES
•

Privacy Act Statement

Authority: The authorities for collecting the requested information from and
about you are 428(b)(2)(A) et seq. and 451 et seq. of the Higher Education Act of
1965, as amended (20 U.S.C. 1078(b)(2)(A) et seq. and 20 U.S.C. 1087a et seq.) and
the authority for collecting and using your Social Security Number (SSN) is 484(a)
(4) of the HEA (20 U.S.C. 1091(a)(4)).

Purpose: The principal purposes for collecting the information on the Teacher
Loan Forgiveness Application, 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 and/or
FFEL Programs, to permit the servicing of your loans, to enforce the conditions or
terms of a title IV, HEA obligation, to originate, disburse, service, collect assign,
adjust, transfer, refer, furnish credit information for, and discharge a title IV HEA
obligation, to verify whether a title IV HEA obligation qualifies for discharge, to
determine credit balances to be refunded by the U.S. Department of the Treasury
(Treasury) to the individual or loan holder, 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.

Disclosures: The information provided on the Teacher Loan Forgiveness
Application form will only be disclosed outside of the U.S. Department of
Education (Department) with prior written consent or as otherwise allowed by the
Privacy Act of 1974, as amended (Privacy Act) (5 U.S.C. 552a). One of the exceptions
to the Privacy Act’s prior written consent requirement that allows for disclosure,
without consent, is for “routine uses” that the Department publishes in our System
of Records Notices (SORNs). The Department may disclose, without consent, the
information provided on a Teacher Loan Forgiveness Application form, on a caseby-case basis or under a computer matching program, to third parties pursuant to
the routine uses identified in the “Common Services for Borrowers (CSB)
System” (18-11-16) SORN. This notice is available on the Department’s “Privacy Act
System of Record Notice Issuances (SORN)” webpage located at https://
www2.ed.gov/notices/ed-pia.html.
The routine uses of this information include, but are not limited to the following:

• To verify the identity of the individual who records indicate has applied for

or received title IV, HEA program funds, disclosures may be made to
guaranty agencies, educational and financial institutions, and their
authorized representatives; to Federal, State, Tribal, or local agencies, and
their authorized representatives; to private parties, such as relatives,
business and personal associates, and present and former employers; to
creditors; to consumer reporting agencies; to adjudicative bodies; and to
the individual whom the records identify as the party obligated to repay the
title IV, HEA obligation;

• To determine program eligibility and benefits, disclosures may be made to

guaranty agencies, educational and financial institutions, and their
authorized representatives; to Federal, State, or local agencies, and their
authorized representatives; to private parties, such as relatives, business and
personal associates, and present and former employers; to creditors; to
consumer reporting agencies; and to adjudicative bodies;

•
•

•

To investigate possible fraud or abuse or to verify compliance with
contractual requirements or Federal, State, local, or Tribal statutory,
regulatory, or program requirements, disclosures may be made to guaranty
agencies, educational and financial institutions, third-party servicers, and
their authorized representatives; to Federal, State, Tribal, or local agencies,
and their authorized representatives; to private parties, such as relatives,
present and former employers, and business and personal associates; to
creditors; to consumer reporting agencies; and to adjudicative bodies;
To locate a delinquent or defaulted borrower, or an individual who owes a
title IV, HEA obligation, disclosures may be made to guaranty agencies;

To verify whether a title IV, HEA obligation qualifies for discharge,
disclosures may be made to guaranty agencies, educational and financial
institutions, and their authorized representatives; to Federal, State, or local
agencies, and their authorized representatives; to private parties, such as
relatives, present and former employers, and business and personal
associates; to creditors; to consumer reporting agencies; and to
adjudicative bodies; and

To prepare a title IV, HEA obligation for litigation, to provide support
services for litigation on a title IV, HEA obligation, to litigate a title IV, HEA
obligation, or to audit the results of litigation on a title IV, HEA obligation,
disclosures may be made to FFEL loan holders or servicers; Department
contractors including but not limited to, Federal Loan Servicers, NFP
Federal Loan Servicers, the Federal Perkins Servicer, PCAs and to guaranty
agencies and their authorized representatives; Federal, State, Tribal, or local
agencies, and their authorized representatives; and to adjudicative bodies.

For additional routine uses, view the “Common Services for Borrowers (CSB)
System” (18-11-16) SORN. This notice is available on the Department’s “Privacy Act
System of Record Notice Issuances (SORN)” webpage located at https://
www2.ed.gov/notices/ed-pia.html.
Consequences of Failure to Provide Information: Participating in the William D.
Ford Federal Direct Loan (Direct Loan) Program or the Federal Family Education
Loan (FFEL) Program and providing the Department with your SSN are voluntary,
but you must provide the requested information, including your SSN, to
participate.
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 valid OMB control number. The valid OMB control number for this
information collection is 1845-0059. Public reporting burden for this collection of
information is estimated to average 20 minutes (0.33 hours) per response,
including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the
information collection. The obligation to respond to this collection is required to
obtain a benefit in accordance with 34 CFR 682.216(f)(1) and 34 CFR 685.217(e)(1).
If you have comments or concerns regarding the status of your individual
submission of this form, contact your loan holder at the address shown in
Section 6.

• To enforce the conditions or terms of a title IV, HEA obligation, disclosures

may be made to guaranty agencies, educational and financial institutions,
and their authorized representatives; to Federal, State, or local agencies, and
their authorized representatives; to private parties, such as relatives,
business and personal associates, and present and former employers; to
creditors; to consumer reporting agencies; to adjudicative bodies; and to
the individual whom the records identify as the party obligated to repay the
title IV, HEA obligation;

• To permit originating, disbursing, servicing, collecting, assigning,

adjusting, transferring, referring, furnishing of credit information, or
discharging title IV, HEA obligations, disclosures may be made to
guaranty agencies, educational institutions, or financial institutions that
originated, held, serviced, or have been assigned the title IV, HEA
obligation, and their authorized representatives; to a party identified by
the debtor as willing to advance funds to repay the title IV, HEA
obligation; to Federal, State, or local agencies, and their authorized
representatives; to private parties, such as relatives, business and
personal associates, and present and former employers; to creditors; to
consumer reporting agencies; and to adjudicative bodies;

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