Direct Loan, FFEL, Perkins and TEACH Grant Total and Permanent Disability Discharge Application and Related Forms

DISCHARGE APPLICATION: TOTAL AND PERMANENT
DISABILITY
TPD-APP

OMB No. 1845-0065
FORM UNDER REVIEW
Exp. Date XX/XX/XXXX

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

This is an application for a total and permanent disability (TPD)
discharge of your Direct Loan, FFEL, and/or Perkins Loan program
loan(s), and/or your Teacher Education Assistance for College and
Higher Education (TEACH) Grant Program service obligation.

If you want to submit a BPQY but do not have one, contact the SSA
office that issued your award and request form SSA-2459. You may also
request a BPQY by calling 1-800-772-1213 or by visiting www.ssa.gov

Throughout this application, the words “we,” “us,” and “our” refer to
the U.S. Department of Education.
Make sure that all requested information is included. Incomplete
information may cause your application to be delayed or rejected. To
qualify for this discharge, you must submit certain documentation from
one of the following sources: (1) the U.S. Department of Veterans
Affairs (VA) or (2) the Social Security Administration (SSA) or (3) certain
licensed or certified medical professionals.
Except for VA or SSA determinations described below, a disability
determination by another federal or state agency does not qualify you
for this discharge.
U.S. Department of Veterans Affairs Documentation
If you are a veteran, you may receive a loan discharge if you are
unemployable due to a service-connected disability. Generally, you can
meet this standard by providing documentation from the VA showing
that you have received one of the following two types of VA disability
determinations: (1) a determination that you have a service-connected
disability (or disabilities) that is 100% disabling; or (2) a determination
that you are totally disabled based on an individual unemployability
rating. You do not qualify for discharge based on a VA disability
determination if your disability is not service-connected.
Social Security Administration Documentation
If you are eligible for Social Security Disability Insurance (SSDI) or
Supplemental Security Income (SSI), you may qualify for a loan
discharge by providing a copy of your SSA notice of award, SSA Benefits
Planning Query (BPQY) or other acceptable documentation (as
determined by the U.S. Department of Education) showing that you
meet one of the following requirements:
1. You qualify for SSDI or SSI based on disability, and your next
scheduled disability review has been scheduled between 5 to 7 years
from the date of your last SSA disability determination;
2. You qualify for SSDI or SSI based on disability and your next
continuing disability review has been scheduled at 3 years;
3. You have an established medical onset date for SSDI or SSI of at least
5 years before the date of your application for TPD discharge, or you
have been receiving SSDI or SSI based on disability for at least 5 years
before the date of your application for TPD discharge;
4. You qualify for SSDI or SSI based on a compassionate allowance; or
5. You are currently receiving SSA retirement benefits, and immediately
before you qualified for SSA retirement benefits, you met one of the
requirements described in paragraphs A through D above.

If you are granted a discharge based on SSA documentation, we will
monitor your status during a 3-year monitoring period. Your discharged
loans or TEACH Grant service obligation may be reinstated if you
receive a new Direct Loan or TEACH Grant during this monitoring
period, as explained in Section 6 of this form.
Authorized Medical Professional Certification
You may qualify for discharge by having an authorized medical
professional (see definition in Section 5) complete Section 4 of this
application. The authorized medical professional must certify that you
are unable to engage in any substantial gainful activity (see definition in
Section 5) by reason of a medically determinable physical or mental
impairment that: (1) can be expected to result in death; (2) has lasted
for a continuous period of at least 60 months; or (3) can be expected to
last for a continuous period of at least 60 months.
If you are granted a discharge based on an authorized medical
professional’s certification, we will monitor your status during a 3-year
monitoring period. Your discharged loans or TEACH Grant service
obligation may be reinstated if you receive a new Direct Loan or TEACH
Grant during this monitoring period, as explained in Section 6.
Important Tax Information
Loan amounts discharged due to TPD are not considered taxable
income by the Internal Revenue Service (IRS) for federal tax purposes.
However, some states may consider the discharged amount to be
income for state tax purposes. Check with your state tax office or a tax
professional before filing your state tax return.
How to Designate Someone to Represent You
If you wish to designate someone to represent you in matters related
to your discharge request, you must complete the Applicant
Representative Designation: Total and Permanent Disability form. You
may obtain this form from our TPD Discharge Servicer (see below).
WHERE TO SEND YOUR COMPLETED APPLICATION AND
DOCUMENTATION
U.S. Department of Education - TPD Servicing
P.O. Box 87130
Lincoln, NE 68501-7130
Fax: 303-696-5250
IF YOU NEED HELP COMPLETING THE APPLICATION
Phone: 1-888-303-7818 (TTY: dial 711, then phone no.)
Email: [email protected]
Website: www.disabilitydischarge.com

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DISCHARGE APPLICATION: TOTAL AND PERMANENT
DISABILITY
TPD-APP

OMB No. 1845-0065
FORM UNDER REVIEW
Exp. Date XX/XX/XXXX

William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family
Education Loan (FFEL) Program / Federal Perkins Loan (Perkins Loan)
Program / TEACH Grant 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: APPLICANT INFORMATION
Please enter or correct the following information.
Check this box if any of your information has changed.
SSN
Date of Birth
Name
Address
City

State

Zip Code

Telephone - Primary
Telephone - Alternate
Email
SECTION 2: TOTAL AND PERMANENT DISABILITY INFORMATION
Carefully read the entire application. Type or print in dark ink. Sign and date the application in Section 3.
1. Are you a veteran who has received a determination from the VA that you are unemployable due to a service-connected disability?
Yes - Attach documentation of the VA determination and complete Section 3. You do not need to have an authorized medical professional complete Section 4.
No - Continue to Item 2.
2. Are you currently receiving SSDI or SSI benefits, or SSA retirement benefits, and does your most recent SSA notice of award, SSA Benefits Planning Query (BPQY), or
other documentation show that you meet one of the requirements A through E listed below?
A. You qualify for SSDI or SSI based on disability, and your next scheduled disability review is between 5 and 7 years from the date of your last SSA disability
determination;
B. You qualify for SSDI or SSI based on disability and your next continuing disability review has been scheduled at 3 years;
C. You have an established onset date for SSDI or SSI of at least 5 years before the date of your application for TPD discharge, or you have been receiving SSDI or
SSI based on disability for at least 5 years before the date of your application for TPD discharge;
D. You qualify for SSDI or SSI based on a compassionate allowance; or
E. You are currently receiving SSA retirement benefits, and before you qualified for SSA retirement benefits, you met one of the requirements described in
paragraphs A through D above.
Yes - Attach a copy of your most recent SSA notice of award or BPQY, or other documentation showing that you meet one of the requirements listed above and
complete Section 3. If you submit documentation other than a notice of award or BPQY it will be reviewed and accepted only if it provides sufficient information
to determine that you meet the requirements above. You do not need to have an authorized medical professional complete Section 4.
No - Complete Section 3 and have an authorized medical professional (see definition in Section 5) complete and sign Section 4.
SECTION 3: APPLICANT'S REQUEST, AUTHORIZATIONS, UNDERSTANDINGS, AND CERTIFICATIONS
I request that the U.S. Department of Education discharge my Direct Loan, FFEL, and/or Perkins Loan program loan(s), and/or my TEACH Grant service obligation.
I authorize any authorized medical professional (as defined in Section 5), hospital, or other institution having records about the disability that is the basis for my
request for a discharge to make information from those records available to the U.S. Department of Education.
I authorize the organization I submit this request to and its agents to contact me regarding my request or my loans at the cellular telephone number that I provide
now or in the future using automated telephone dialing equipment or artificial or prerecorded voice or text messages.
I understand that: (1) If I am applying for a discharge based on an authorized medical professional’s certification in Section 4, I must submit this application to the
U.S. Department of Education within 90 days of the date of the authorized medical professional’s signature in Section 4; and (2) if I am a veteran who answered No
to Item 1 in Section 2, and I obtained a certification from an authorized medical professional in Section 4, that certification is only for purposes of determining my
eligibility for a discharge of my loan(s) or TEACH Grant service obligation, and is not for purposes of determining my eligibility for, or the extent of my eligibility for, VA
benefits.
I certify that: (1) I have a total and permanent disability, as defined in Section 5; and (2) I have read and understand the information in Sections 6 and 7.

Applicant’s or Representative’s Signature

Date

Representative Name (if applicable)

NOTE: You may designate someone to represent you in matters related to your application. If you wish to designate a representative, you must complete the
Applicant Representative Designation: Total and Permanent Disability form.

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Applicant Name _________________________________________________________

Applicant SSN ____________________________

SECTION 4: AUTHORIZED MEDICAL PROFESSIONAL CERTIFICATION
6. Describe the severity of the applicant's impairment, including, if applicable,
the phase of the impairment:

Print legibly and initial any changes. Return the form to the applicant or
representative.
Applicant Identification
1. Provide the below information regarding the individual for whom you are
completing this Section:

Limitations

Name _______________________________________________
Date of Birth ___________________________
Medically Determinable Physical or Mental Impairment
2. Does the applicant have a medically determinable physical or mental
impairment that prevents the applicant from engaging in any substantial
gainful activity? Substantial gainful activity means a level of work performed
for pay or profit that involves doing significant physical or mental activities or
a combination of both. If the applicant is able to engage in any substantial
gainful activity in any field of work, you must answer "No".
Yes - Continue to Item 3.

Explain how the condition prevents the applicant from engaging in any
substantial gainful activity in any field of work. Attach additional pages if
needed. Enter "N/A" if not applicable. You may include additional information
you believe is helpful in understanding the applicant's condition, such as
medications or procedures used to treat the condition.
7. Limitations on sitting, standing, walking, or lifting:

8. Limitations on activities of daily living:

No - Do not complete this application.
Severity/Duration of Physical or Mental Impairment

9. Residual functionality:

3. Is the applicant's impairment expected to result in death?
Yes - Skip to Item 5.
No - Continue to Item 4.
4. Has the applicant's impairment lasted or is it expected to last for a continuous
period of at least 60 months?

10. Social/behavioral limitations (if any):

Yes - Continue to Item 5.
11. Global Assessment Function Score (for psychiatric conditions):

No - Do not complete this application.
Disabling Condition
Do not use insurance codes or abbreviations.
5. Provide your diagnosis of the applicant's impairment:

Authorized Medical Professional’s Certification
I certify that, in my best professional judgment, the applicant identified in Item 1 has a medically determinable physical or mental impairment consistent with my
responses in Items 2 through 10. I understand that an applicant who is currently able to engage in any substantial gainful activity in any field of work does not have a
total and permanent disability as defined on this form. I am a:
doctor of medicine legally authorized to practice in a state
doctor of osteopathy/osteopathic medicine legally authorized to practice in a state
nurse practitioner licensed by a state
physician assistant licensed by a state
certified psychologist at the independent practice level licensed to practice in the United States
State Where Legally Authorized to Practice or Licensed*

Professional License Number (subject to verification; stamp is acceptable)

*If you are licensed to practice in American Samoa, Puerto Rico, the U.S. Virgin Islands, the Northern Mariana Islands, the Marshall Islands, Micronesia, or Palau,
attach a copy of your professional license that clearly shows the expiration date.
Signature (a stamp is not acceptable)

Address (a stamp is acceptable)

Date (mm-dd-yyyy)

Email

Name (First, Middle, Last)

Telephone

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Fax

SECTION 5: DEFINITIONS
An authorized medical professional who may complete Section 4 of this
form is:
•
•
•
•

a doctor of medicine or osteopathy legally authorized to practice
in a state;
a nurse practitioner licensed by a state;
a physician assistant licensed by a state; or
a certified psychologist at the independent practice level who is
licensed to practice in the United States.

If you have a total and permanent disability, this means that: (1) you are
unable to engage in any substantial gainful activity by reason of a medically
determinable physical or mental impairment that can be expected to result
in death, or that has lasted for a continuous period of not less than 60
months, or that can be expected to last for a continuous period of not less
than 60 months; OR (2) you are a veteran who has been determined by the
VA to be unemployable due to a service-connected disability. Except for
certain VA or SSA determinations as explained elsewhere on this form, a
disability determination by another federal or state agency does not
establish your eligibility for a discharge of your loan(s) and/or TEACH Grant
service obligation due to a total and permanent disability.
Substantial gainful activity means a level of work performed for pay or
profit that involves doing significant physical or mental activities, or a
combination of both.
A discharge of a loan due to a total and permanent disability cancels your
obligation (and, if applicable, an endorser's obligation) to repay the
remaining balance on your Direct Loan, FFEL, and/or Perkins Loan program
loans.
A discharge of a TEACH Grant service obligation cancels your obligation to
complete the teaching service that you agreed to perform as a condition for
receiving a TEACH Grant.
The post-discharge monitoring period begins on the date we grant a
discharge of your loan(s) or TEACH Grant service obligation and lasts for
three years. If at any time during the post-discharge monitoring period, you
receive a new loan under the Direct Loan Program or a new TEACH Grant,
we will reinstate your obligation to repay your loan(s) or complete your
TEACH Grant service.

The William D. Ford Federal Direct Loan (Direct Loan) Program includes
Federal Direct Stafford/Ford Loans (Direct Subsidized Loans), Federal Direct
Unsubsidized Stafford/Ford Loans (Direct Unsubsidized Loans), Federal
Direct PLUS Loans (Direct PLUS Loans), and Federal Direct Consolidation
Loans (Direct Consolidation 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.
The Federal Perkins Loan (Perkins Loan) Program includes Federal Perkins
Loans, National Direct Student Loans (NDSL), and National Defense Student
Loans (Defense Loans).
The Teacher Education Assistance for College and Higher Education
(TEACH) Grant Program requires individuals to complete a teaching service
obligation as a condition for receiving a TEACH Grant.
The holder of your FFEL Program loan(s) may be a lender, a guaranty
agency, or the U.S. Department of Education. The holder of your Perkins
Loan Program loan(s) may be a school you attended or the U.S. Department
of Education. The holder of your Direct Loan Program loan(s) and/or your
TEACH Grant Agreement to Serve (if you received a TEACH Grant) is the U.S.
Department of Education. Your loan holder may use a servicer to handle
billing and other matters related to your loan. The term “holder” as used on
this application means either your loan holder or, if applicable, your loan
servicer.
The term “state” for purposes of the authorized medical professional’s
certification in Section 4 (the authorized medical professional must be
licensed to practice in a state) includes the 50 United States, the District of
Columbia, American Samoa, the Commonwealth of Puerto Rico, Guam, the
U.S. Virgin Islands, the Commonwealth of the Northern Mariana Islands, the
Republic of the Marshall Islands, the Federated States of Micronesia, and
the Republic of Palau.
A representative is a member of your family, an attorney, a law firm or
legal aid society, or another individual or organization authorized to act on
your behalf in connection with your total and permanent disability
discharge application.

Note to Veterans: The post-discharge monitoring period does not apply
if you are a veteran who receives a discharge based on a qualifying
disability determination from the VA as described in item (2) of the
definition of “total and permanent disability”.

SECTION 6: DISCHARGE PROCESS/ELIGIBILITY REQUIREMENTS/TERMS AND CONDITIONS FOR DISCHARGE
Applying for discharge (all applicants):
Submission of discharge application. After you submit your completed
application and documentation to us, we will send you a notice that will:
•
•
•

Acknowledge receipt of your application;
Explain the process for our review of your application; and
Explain that you are not required to make any payments on your
loans while we review your application for discharge.

Consequences of failure to submit an application. If you do not submit an
application to us within 120 days of notifying us that you intend to submit
an application, collection activity will resume on your loans. If you have a
FFEL Program loan and the holder of the loan is a lender, the lender may
capitalize any unpaid interest that accrued while collection activity was
suspended. This means that the unpaid interest will be added to the
principal balance of your loan, and interest will then be charged on the
increased loan principal amount. If you have a Direct Loan, a FFEL Program
loan that is held by the U.S. Department of Education or a guaranty agency,
or a Federal Perkins Loan, unpaid interest will not be capitalized.

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SECTION 6: DISCHARGE PROCESS/ELIGIBILITY REQUIREMENTS/TERMS AND CONDITIONS FOR DISCHARGE (CTD.)
Discharge process for veterans who have received a qualifying disability
determination from the VA:
Our review of your discharge application. We will review the
documentation from the VA to determine if you are totally and
permanently disabled as described in item (2) of the definition of “total and
permanent disability” in Section 5 of this application.
Determination of eligibility or ineligibility for discharge. If we determine
that you are totally and permanently disabled, you will be notified that your
loans and/or TEACH Grant service obligation has been discharged. The
discharge will be reported to nationwide consumer reporting agencies, and
any loan payments received on your loan on or after the effective date of
the determination by the VA that you are unemployable due to a serviceconnected disability will be refunded to the person who made the
payments.
If we determine that you are not totally and permanently disabled, you will
be notified of that determination. The notification will include:
•
•

•
•

The reason or reasons for the denial of your discharge
application;
An explanation that your loans are due and payable to the loan
holder under the terms of the promissory note that you signed
and that your loans will return to the status they were in at the
time you applied for a total and permanent disability discharge;
An explanation that your loan holder will notify you of the date
you must resume making payments on your loans; and
An explanation that if you applied for a discharge of a TEACH
Grant service obligation, you must comply with all terms and
conditions of your TEACH Grant Agreement to Serve.

The notification will also explain your ability to request reconsideration of
this determination or to submit a new discharge application:
•

•

You may request that we re-evaluate your discharge application
by providing additional documentation from the VA that
supports your eligibility for discharge. If you provide this
documentation within 12 months of the date of our notification
that you are ineligible for discharge, you do not have to submit a
new application. After 12 months, a new application is required.
If the documentation from the VA does not indicate that you are
unemployable due to a service-connected disability, you may
reapply for discharge under the “Discharge Process For All Other
Applicants”. You must submit a new application with the
required documentation from the SSA or an authorized medical
professional’s certification in Section 4.

application. We may also contact the authorized medical professional for
additional information, or may arrange for an additional review of your
condition by an independent physician or other medical professional at our
expense. Based on the results of this review, we will determine your
eligibility for a discharge.
If we determine during our review of your application that you received a
Direct Loan or a TEACH Grant before the date we received the SSA notice of
award or BPQY, or other acceptable documentation, or before the date the
authorized medical professional certified your application in Section 4, and
a disbursement of that loan or grant is made after that date, but before we
have granted a discharge, we will suspend processing of your discharge
request until you ensure that the full amount of the disbursement is
returned toto us.
If you apply for a total and permanent disability discharge and we
determine as part of our review that a new Direct Loan or a new TEACH
Grant was made to you on or after the date we received the SSA notice of
award or BPQY, or other acceptable documentation, or on or after the date
the authorized medical professional certified your application in Section 4,
and before the date we grant a discharge, we will deny your discharge
request. Collection will resume on your loans and you will again be
responsible for complying with the terms and conditions of your TEACH
Grant Agreement to Serve.
Determination of eligibility or ineligibility for discharge. If we determine
that you are totally and permanently disabled, we will notify you that a
discharge has been approved, and that you will be subject to a postdischarge monitoring period for three years beginning on the discharge
date. The notification of discharge will explain the terms and conditions
under which we will reinstate your obligation to repay your loan or to
complete your TEACH Grant service obligation. The discharge will be
reported to nationwide consumer reporting agencies, and any loan
payments that were received after the date we received the SSA notice of
award or BPQY, or other acceptable documentation, or after the date the
authorized medical professional certified your discharge application will be
returned to the person who made the payments.
If we determine that you are not totally and permanently disabled, you will
be notified of that determination. The notification will include:

Discharge process for all other applicants:

•
•

•

Our review of your discharge application. If you submit a discharge
application supported by an award of benefits notice from the SSA, SSA
Benefits Planning Query (BPQY), or other acceptable documentation, we
will review that documentation to determine if it meets the requirements
described in Section 2, Item 2 of this form.
If you submit a discharge application supported by an authorized medical
professional’s certification in Section 4 of this application, we will review
the certification and any accompanying documentation to determine if you
are totally and permanently disabled as described in item (1) of the
definition of “total and permanent disability” in Section 5 of this

Page 5 of 7

•

The reason or reasons for the denial of your discharge
application;
An explanation that your loans are due and payable to the loan
holder under the terms of the promissory note that you signed
and that your loans will return to the status that would have
existed if your total and permanent disability discharge
application had not been received;
An explanation that your loan holder will notify you of the date
you must resume making payments on your loans;
An explanation that if you applied for a discharge of a TEACH
Grant service obligation, you must comply with all terms and
conditions of your TEACH Grant Agreement to Serve or Repay;

SECTION 6: DISCHARGE PROCESS/ELIGIBILITY REQUIREMENTS/TERMS AND CONDITIONS FOR DISCHARGE (CTD.)
Discharge process for all other applicants (continued):
Determination of eligibility or ineligibility for discharge (continued).
•

•

•

An explanation that you are not required to submit a new total
and permanent disability discharge application if, within 12
months of the date of our notification to you that you are
ineligible for discharge, you provide additional information
regarding your disabling condition that supports your eligibility
for discharge, and you request that we re-evaluate your
discharge application; and
An explanation that if you do not request re-evaluation of your
prior discharge application within 12 months of the date of our
notification of ineligibility for discharge, and you still wish to have
us re-evaluate your eligibility for a total and permanent disability
discharge, you must submit a new total and permanent disability
discharge application to us.
If you request a re-evaluation of your total and permanent
disability discharge application or submit a new total and
permanent disability discharge application, as described above,
your request must include new information regarding your
disabling condition that was not provided to us in connection
with your prior application for discharge.

If at any time during the post-discharge monitoring period, you receive a
new loan under the Direct Loan Program or a new TEACH Grant, we will
reinstate your obligation to repay your loans and/or to complete your
TEACH Grant service. If your loans are reinstated, you will be responsible
for repaying your loans to us in accordance with the terms of your
promissory note(s). Your loans will be returned to the status that would
have existed if we had not received your total and permanent disability
discharge application. However, you will not be required to pay interest on
your loans for the period from the date of the discharge until the date your
repayment obligation was reinstated. We will be your loan holder. If your
TEACH Grant service obligation is reinstated, you will again be subject to
the requirements of your TEACH Grant Agreement to Serve or Repay and
must complete your service obligation within the portion of your eight-year
service obligation period that remained after the date of the total and
permanent disability discharge. If you do not meet the terms of that
agreement and the TEACH Grant funds you received are converted to a
Direct Unsubsidized Loan, you must repay that loan in full, and interest will
be charged from the date(s) that the TEACH Grant funds were disbursed.
If your obligation to repay your loans or to complete your TEACH Grant
service obligation is reinstated, we will notify you of the reinstatement. This
notification will include:
•
•

Post-discharge monitoring period and reinstatement of obligation to
repay discharged loans or complete discharged TEACH Grant service
obligation. If you are granted a discharge, we will monitor your status
during the 3-year post-discharge monitoring period that begins on the date
the discharge is granted.

•

The reason or reasons for the reinstatement;
For loans, an explanation that the first payment due date on the
loan following the reinstatement will be no earlier than 90 days
following the date of the notification of reinstatement; and
Information on how you may contact us if you have questions
about the reinstatement, or if you believe that your obligation to
repay a loan or complete your TEACH Grant service obligation
was reinstated based on incorrect information.

SECTION 7: ELIGIBILITY REQUIREMENTS TO RECEIVE FUTURE LOANS OR TEACH GRANTS
For veterans who receive a total and permanent disability discharge based
on a qualifying disability determination by the VA:

For all other individuals who receive a total and permanent disability
discharge:

If you are a veteran who is granted a discharge based on a determination
that you are totally and permanently disabled as described in item (2) of
the definition of “total and permanent disability” in Section 5 of this
application, you are not eligible to receive future loans under the Direct
Loan Program or future TEACH Grants, unless:

If you are granted a discharge based on a determination that you are totally
and permanently disabled in accordance with item (1) of the definition of
“total and permanent disability” in Section 5 of this application, you are not
eligible to receive future loans under the Direct Loan Program or future
TEACH Grants, unless:

•
•

You obtain a certification from a physician that you are able to
engage in substantial gainful activity; and
You sign a statement acknowledging that the new loan or TEACH
Grant service obligation cannot be discharged in the future on
the basis of any injury or illness present at the time the new loan
or TEACH Grant is made, unless your condition substantially
deteriorates so that you are again totally and permanently
disabled.

•
•

•

Page 6 of 7

You obtain a certification from a physician that you are able to
engage in substantial gainful activity;
You sign a statement acknowledging that the new loan or TEACH
Grant service obligation cannot be discharged in the future on
the basis of any injury or illness present at the time the new loan
or TEACH Grant is made, unless your condition substantially
deteriorates so that you are again totally and permanently
disabled; and
If you request a Direct Loan Program loan or a new TEACH Grant
within three years of the date that a previous loan or TEACH
Grant was discharged, you resume payment on the previously
discharged loan or acknowledge that you are once again subject
to the terms of the TEACH Grant Agreement to Serve before
receiving the new loan.

SECTION 8: WHERE TO SEND THE COMPLETED DISCHARGE APPLICATION
Return the completed form and any documentation to:

If you need help completing this form, contact us:

U.S. Department of Education - TPD Servicing
P.O. Box 87130
Lincoln, NE 68501-7130
Fax to: 303-696-5250
Email to: [email protected]

Phone: 1-888-303-7818 (TTY: dial 771, then phone no.)
Email: [email protected]
Website: www.disabilitydischarge.com

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., §451 et seq., §461, or §420L of the Higher Education
Act of 1965, as amended (20 U.S.C. 1071 et seq., 20 U.S.C. 1087a et seq., 20
U.S.C. 1087aa et seq., or 20 U.S.C. 1070g 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 Direct Loan, FFEL, Perkins Loan, or TEACH
Grant 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, FFEL, Federal Perkins Loan or TEACH
Grant 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.

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 1845-0065. Public
reporting burden for this collection of information is estimated to average
30 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 674.61(b) or (c), 34 CFR 682.402(c)(2) or (c)(9), 34
CFR 685.213(b) or (c), and 34 CFR 686.42(b). If you have comments or
concerns regarding the status of your individual submission of this form,
please contact the U.S. Department of Education directly (see Section 6).

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.

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