FEDERAL PERKINS LOAN MASTER PROMISSORY NOTE—DRAFT Revisions 

OMB No. 1845-0074 Form Under Review 60 Day Comment Period Expiration Date / XX/XX/XXXX

Page 1 of 4

Section A: Borrower Section

1. Name (last, first, middle initial) and

Permanent Address (street, city, state, zip code)

2. Social Security Number

3. Date of Birth (mm/dd/yyyy)

4. Home Area Code/Telephone Number

5. Driver's License Number (List state abbreviation first)

Section B: School Section

6. School Name & Address (street, city, state, zip code) 7. Annual Interest Rate

5%

[Any bracketed clause or paragraph may be included at option of institution]

Terms and Conditions: (Note: Additional Terms and Conditions follow on subsequent pages)

APPLICABLE LAW - The terms of this Federal Perkins Loan Master Promissory Note (hereinafter called the Note) and any disbursements made under this Note shall be 

interpreted in accordance with Part E of Title IV of the Higher Education Act of 1965, as amended (hereinafter called the Act), as well as Federal regulations issued under the

Act. All sums advanced under this Note are subject to the Act and Federal regulations issued under the Act.

REPAYMENT - I am obligated to repay the principal and the interest that accrues on my loan(s) to the above-named institution (hereinafter called the School) over a period 

beginning 9 months (or sooner if I am a Less-Than-Half-Time Borrower) after the date I cease to be at least a half-time student at an institution of higher education or a 

comparable School outside the United States approved by the United States Department of Education (hereinafter called the Department) and ending 10 years later, unless I 

request in writing that my repayment period begin sooner. I understand that the School will report the amount of my installment payments, along with the amount of this loan 

to at least one national credit bureau. Interest on this loan shall accrue from the beginning of the repayment period. My repayment period may be shorter than 10 years if I am 

required by my School to make minimum monthly payments. My repayment period may be extended during periods of deferment, hardship, or forbearance and I may make 

graduated installments in accordance with a schedule approved by the Department. I will make my installment payments in equal monthly, bimonthly, or quarterly 

installments as determined by the School. The School may round my installment payment to the next highest multiple of $5. [I will make a minimum monthly repayment of 

$40 (or $30 if I have outstanding Federal Perkins Loans made before October 1, 1992 that included the $30 minimum payment option or outstanding National Direct Student 

Loans) in accordance with the Minimum Monthly Payment Section of the Terms and Conditions contained on the reverse side of this document.]

LATE CHARGES - The School may impose late charges if I do not make a scheduled payment when due or if I fail to submit to the School on or before the due date of the 

payment, a properly documented request for any of the forbearance, deferment, or cancellation benefits as described below. No late charges may exceed 20 percent of my 

monthly, bimonthly, or quarterly payment. The School may add the late charges to principal the day after the scheduled payment was due or include it with the next 

scheduled payment after I have received notice of the charge, and such notice is sent before the next installment is due.

FORBEARANCE, DEFERMENT, OR CANCELLATION - I may apply for a forbearance, deferment, or cancellation on my loan. During an approved forbearance 

period, payments of principal and interest, or principal only, may be postponed or reduced. Interest continues to accrue while my loan is in forbearance. During an approved 

deferment period, I am not required to make scheduled installment payments on my loan. I am not liable for any interest that might otherwise accrue while my loan is in 

deferment. If I meet the eligibility requirements for a cancellation of my loan, the institution may cancel up to 100 percent of the outstanding principal loan amount. 

Information on eligibility and application requirements for forbearances, deferments, and cancellations is provided on pages 2 through 4 of this Note. I am responsible for 

submitting the appropriate requests on time, and I may lose my benefits if I fail to file my request on time.

DEFAULT - The School may, at its option, declare my loan to be in default if (1) I fail to make a scheduled payment when due; (2) I fail to submit to the School, on or 

before the due date of a scheduled payment, documentation that I qualify for a forbearance, deferment, or cancellation; or (3) I fail to comply with the terms and conditions of 

this Note or written repayment agreement. The School may assign a defaulted loan to the Department for collection. I will be ineligible for any further federal student 

financial assistance authorized under the Act until I make arrangements that are satisfactory to the School or the Department to repay my loan. The School or the Department 

shall disclose to credit bureau organizations that I have defaulted and all other relevant loan information. I will lose my right to defer payments and my right to forbearance if 

I default on my loan. The School or the Department may accelerate my defaulted loan. Acceleration means that the School or the Department demands immediate payment 

of the entire unpaid balance of the loan, including principal, interest, late charges, and collection costs. I will lose my right to receive cancellation benefits for service that is 

performed after the date the School or the Department accelerated the loan.

CHANGE OF STATUS - I will inform the School of any change in my name, address, telephone number, Social Security Number, or driver's license number.

AUTHORIZATION: - I authorize the School, the Department, and their respective agents and contractors to contact me regarding my loan request or my loan(s), including 

repayment of my loan(s), at the current or any future number that I provide for my cellular phone or other wireless device using automated telephone dialing equipment or 

artificial or pre-recorded voice or text messages.

PROMISE TO PAY: I promise to pay the School, or a subsequent holder of the Note, all sums disbursed under the terms of this Note, plus interest and other fees which 

may become due as provided in this Note. I understand that multiple loans may be made to me under this Note. I understand that by accepting any disbursements issued 

at any time under this Note, I agree to repay the loans. I understand that each loan is separately enforceable based on a true and exact copy of this Note. I understand that I

may cancel or reduce the amount of any loan by not accepting or by returning all or a portion of any disbursement that is issued. If I do not make any payment on any loan 

under this Note when it is due, I promise to pay all reasonable collection costs, including attorney fees, court costs, and other fees. I will not sign this Note before reading the 

entire Note, even if I am told that I am not required to read it. I am entitled to an exact copy of this Note. This loan has been made to me without security or endorsement. 

My signature certifies I have read, understand, and agree to the terms and conditions of this Note. 

I UNDERSTAND THAT I MAY RECEIVE ONE OR MORE LOANS UNDER THIS MASTER PROMISSORY NOTE AND THAT I MUST REPAY SUCH 

LOANS.

Borrower’s Signature Date
Terms and Conditions (cont.)

Page 2 of 4

DISCLOSURE OF LOAN TERMS - I understand that under this Note, the 

principal amount that I owe, and am required to repay, will be the sum of all 

disbursements issued unless I reduce or cancel any disbursements. The 

School will determine whether to make any loan under this Note after my 

loan eligibility is determined. At or before the time of first disbursement for 

each loan, a disclosure statement will be provided to me identifying the 

amount of the loan and any additional terms of the loan. I may decline a loan 

or request a lower amount by contacting the School. Any disclosure 

statement I receive in connection with any loan under this Note is hereby 

incorporated into this Note.

LOAN REHABILITATION - If I default on my Federal Perkins Loan, 

and that loan has not been reduced to a judgment as a result of litigation 

against me, I may rehabilitate my defaulted loan by requesting the 

rehabilitation and by making a voluntary, on-time, monthly payment, as 

determined by the School, each month for nine consecutive months. If I 

successfully rehabilitate my defaulted Federal Perkins Loan, I will again be 

subject to the terms and conditions and qualify for any remaining benefits 

and privileges of this Note and the default will be removed from my credit 

history. I understand that I may rehabilitate a defaulted Federal 

Perkins Loan only once. After my loan is rehabilitated, collection costs on 

the loan may not exceed 24 percent of the unpaid principal and accrued 

interest as of the date following the application of the ninth consecutive 

payment. If I default on my rehabilitated loan, the cap on collection costs is 

removed.

ASSIGNMENT - A loan made under this Note may be assigned by the 

School only to the United States, as represented by the United States 

Department of Education. Upon assignment, the provisions of this Note 

that relate to the School will, where appropriate, relate to the Department.

HARDSHIP REPAYMENT OPTIONS - Upon my written request, the 

School may extend my repayment period (1) for up to an additional 10 

years if I qualify as a low-income individual during the repayment period; 

or (2) for the period necessary beyond my 10 year repayment period if, in 

the School’s opinion, prolonged illness or unemployment prevent me from 

making the scheduled repayments. Interest will continue to accrue during 

any extension of a repayment period.

If I am required by the School to make a minimum monthly payment on my 

loan, the School may also permit me to pay less than the minimum monthly 

payment amount for a period of not more than one year at a time if I

experience a period of prolonged illness or unemployment. However, such 

action may not extend the repayment period beyond 10 years.

GRACE PERIODS - Unless I am a Less-Than-Half-Time Borrower, I will 

receive an initial nine-month grace period before the first payment of my 

Federal Perkins Loan must be made. After the close of an authorized 

deferment period, I will receive a post-deferment grace period of 6 months 

before my payments resume. Interest does not accrue during the initial 

grace period or during the post-deferment grace period. The nine-month 

initial grace period for Federal Perkins Loans does not include any period 

up to three years during which I am called or ordered to active duty for 

more than 30 days from a reserve component of the Armed Forces of the 

United States, including the period necessary for me to resume enrollment 

at the next available enrollment period. I must notify the school that made 

my loan of the beginning and ending dates of my service, and the date I

resume enrollment. If I am in my initial grace period when called or 

ordered to active duty, I am entitled to a new nine-month initial grace period 

upon completion of the excluded period.

If I am a Less-Than-Half-Time Borrower with outstanding Federal Perkins 

Loans, my repayment period begins when the next scheduled installment of 

my outstanding loan is due. If I am a Less-Than-Half-Time Borrower with 

no other outstanding Federal Perkins Loans, my repayment begins the 

earlier of: 9 months from the date my loan was made, or 9 months from the 

date I became a less-than-half-time student, even if I received the loan after 

I became a less-than-half-time student.

PREPAYMENT - I may prepay all or any part of my unpaid loan balance, 

plus any accrued interest, at any time without penalty. Amounts I repay in 

the academic year in which the loan was made and before the initial grace 

period has ended will be used to reduce the amount of the loan and will not 

be considered a prepayment. If I repay amounts during the academic year 

in which the loan was made and the initial grace period has ended, only 

those amounts in excess of the amount due for any repayment period shall 

be considered a prepayment. If, in an academic year other than the 

academic year in which the loan was made, I repay more than the amount 

due for an installment, the excess funds will be used to repay principal 

unless I designate it as an advance payment of the next regular installment.

MINIMUM MONTHLY PAYMENT - If required by the School, I will 

make a minimum monthly payment in the amount of $40 (or $30 if I have 

outstanding Federal Perkins Loans made before October 1, 1992 that 

included the $30 minimum payment option or outstanding National Direct 

Student Loans) or its bimonthly or quarterly equivalent. If the total monthly 

payment amount on this loan and any outstanding Federal Perkins Loans I

may have is less than the minimum monthly payment amount established by 

the School, the School may still require a minimum monthly payment 

amount. A minimum monthly payment amount will combine my obligation 

on this and all my outstanding Federal Perkins Loans, unless I have received 

loans with different grace periods and deferments. At my request and if I

am eligible, the school may combine this minimum monthly payment 

amount with all my outstanding Federal Perkins Loans including those 

made at other schools. Under these circumstances the portions of the 

minimum monthly payment that will be applied to this loan will be the 

difference between the minimum monthly payment amount and the total 

amounts owed on a monthly basis on my other Federal Perkins Loans. If 

each school holding my outstanding Federal Perkins Loans exercises the 

minimum monthly payment amount option, the minimum monthly payment 

amount will be divided among the Schools in proportion to the loan amount 

advanced by each school if I request this treatment from each School.

FORBEARANCE - Upon making a properly documented written or oral 

request to the School, I am entitled to forbearance of principal and interest 

or principal only, renewable at intervals of up to 12 months for periods that 

collectively do not exceed three years, under the following conditions: If 

my monthly Title IV loan debt burden equals or exceeds 20 percent of my 

total monthly gross income; if the Department authorizes a period of 

forbearance due to a national military mobilization or other national 

emergency; or if the School determines that I qualify due to poor health or 

for other reasons, including service in AmeriCorps. Interest accrues during 

any period of forbearance.

DEFERMENTS - To apply for a deferment, I must request the deferment 

from the school. My request does not have to be in writing, but the School 

may require that I submit supporting documentation to prove my eligibility 

for a deferment. I may defer making scheduled installment payments and 

will not be liable for any interest that might otherwise accrue (1) during any 

period that I am enrolled and attending as a regular student in at least a halftime course of study at an eligible School (if the School obtains student 

enrollment information showing that I qualify for this deferment, the School 

may grant the deferment without my request providing the School notifies 

me and gives me the option to cancel the deferment); (2) during any period 

that I am enrolled and attending as a regular student in a graduate fellowship 

program approved by the Department; engaged in graduate or post-graduate 

fellowship-supported study outside the US; enrolled and attending a 

rehabilitation training program for disabled individuals approved by the 

Department; or engaged in public service that qualifies me to have part or 

all of my loan canceled; (3) for a period not to exceed three years during 

which I am seeking but unable to find full-time employment; (4) for a 

period not to exceed three years, for up to one year at a time, during which I

am experiencing an economic hardship as determined by the School. I may 

qualify for an economic hardship deferment for my Federal Perkins Loan if 

I provide my school with documentation showing that I have been granted 

such a deferment under the William D. Ford Federal Direct Loan or Federal 

Family Education Loan program for the period of time for which I am 

requesting an economic hardship deferment for my Federal Perkins Loan. If 

I am serving as a volunteer in the Peace Corps, I am eligible for an 

economic hardship deferment for my full term of service. An economic 

hardship deferment based on service as a Peace Corps volunteer may not 

exceed the lesser of three years or my remaining period of economic 

hardship eligibility; (5) , during any period when I am serving on active 

duty during a war or other military operation or national emergency, or 

performing qualifying National Guard duty during a war or other military 

operation or national emergency (as these terms are defined in 34 CFR 

674.34(h) of the Perkins Loan Program regulations) and, , for an 

additional 180-day period following the demobilization date for my 

service; and (6) for at least a 30-day period, for up to 13 months 

following the conclusion of my active duty military service and initial 

grace period or until I return to enrolled student status, whichever is 

earlier, if I am a member of the National Guard or other reserve 
Terms and Conditions (cont.)

Page 3 of 4

component of the Armed Forces of the United States or a member of such 

forces in retired status (as these terms are defined in 34 CFR 674.34(i)(2)) 

and I was enrolled in a program of instruction at the time I was called to 

active duty, or within six months prior to the time I was called to active 

duty. Active duty does not include active duty for training or attendance 

at a service school or employment in a full-time, permanent position in 

the National Guard unless I am reassigned from that position to another 

form of active duty service.

I may continue to defer making scheduled installment payments and will 

not be liable for any interest that might otherwise accrue for a six-month

period immediately following the expiration of any deferment period 

described in this section. 

I am not eligible for a deferment while serving in a medical internship or 

residency program.

CANCELLATIONS - Upon making a properly documented written 

request to the School, I am entitled to have up to 100 percent of the original 

principal loan amount of this loan canceled if I perform qualifying service in 

the areas listed in paragraphs A through K below. Other cancellation 

percentages apply if I perform qualifying service in the areas listed in 

paragraphs L and M, as explained in those paragraphs. Qualifying service 

must be performed after the enrollment period covered by the loan.

A. Teaching  a full-time teacher in a public or other nonprofit elementary 

or secondary school or in a school or location operated by an educational 

service agency that has been designated by the Department in accordance 

with the provisions of section 465(a)(2) of the Act as a school with a high 

concentration of students from low-income families. An official Directory 

of designated low-income schools and locations operated by educational 

service agencies is published annually by the Department.  a full-time 

special education teacher in a public or nonprofit elementary or secondary 

school system, including a system administered by an educational service 

agency; or  a full-time teacher, in a public or other nonprofit elementary or 

secondary school system who teaches mathematics, science, foreign 

languages, bilingual education, or any other field of expertise that is 

determined by the State Department of Education to have a shortage of 

qualified teachers in that State.

B. Early Intervention Services  a full-time qualified professional provider 

of early intervention services in a public or other nonprofit program under 

public supervision by a lead agency as authorized by section 632(5) of the 

Individuals with Disabilities Education Act. Early intervention services are 

provided to infants and toddlers with disabilities.

C. Law Enforcement or Corrections Officer  a full-time law 

enforcement officer for an eligible local, State, or Federal law enforcement 

agency; or  a full-time corrections officer for an eligible local, State, or 

Federal corrections agency.

D. Nurse or Medical Technician  a full-time nurse providing health care 

services; or  a full-time medical technician providing health care services.

E. Child or Family Service Agency  a full-time employee of an eligible 

public or private non-profit child or family service agency who is directly 

providing or supervising the provision of services to high-risk children who 

are from low-income communities and the families of such children.

F. Attorneys Employed in a Defender Organization  a full-time 

attorney employed in a defender organization established in accordance 

with section 3006(g)(2) of title 18, U.S.C.

G. Firefighters  a full-time firefighter for a local, State or Federal fire 

department or fire district.

H. Tribal College or University Faculty  a full-time faculty member at a 

Tribal College or University, as that term is defined in section 316 of title 

20, U.S.C.

I. Librarian  a full-time librarian who has a master’s degree in library 

science and is employed in an elementary or secondary school that is 

eligible for assistance under part A of title I of the Elementary and 

Secondary Education Act of 1965, or who is employed in a public library 

that serves a geographic area that contains one or more such schools.

J. Speech-Language Pathologist  a full-time speech-language pathologist 

who has a master’s degree and who is working exclusively with schools that 

are eligible for assistance under title I of the Elementary and Secondary 

Education Act of 1965.

K. Service in an Early Childhood Education Program  a full-time staff 

member in the educational component of a Head Start program, or a fulltime staff member in a pre-kindergarten or child care program that is 

licensed or regulated by the State. The program must be operated for a 

period comparable to a full School year and must pay a salary comparable 

to an employee of a local educational agency.

Cancellation Rates - For each completed year of service under paragraphs 

A, B, C, D, E, F, G, H, I, and J a portion of this loan will be canceled at the 

following rates:

 15 percent of the original principal loan amount for each of the first and 

second years;  20 percent of the original principal loan amount for each of 

the third and fourth years; and  30 percent of the original principal loan 

amount for the fifth year.

For each completed year of service under paragraph K (Service in an Early 

Childhood Education Program), a portion of this loan will be canceled at 

the rate of 15 percent of the original principal loan amount .

L. Military Cancellation - Upon making a properly documented written 

request to the School, I am entitled to have up to100 percent of the principal 

amount of this loan canceled for qualifying service performed after the 

enrollment period covered by the loan as:  a member of the Armed Forces 

of the United States in an area of hostilities that qualifies for special pay 

under section 310 of Title 37 of the United States Code.

Cancellation Rate - For each completed year of service under the Military 

Cancellation provision. This loan will be canceled at the following rates: 

15 percent of the original principal loan amount for each of the first and 

second years;  20 percent of the original principal loan amount for each of 

the third and fourth years; and  30 percent of the original principal loan 

amount for the fifth year.

M. Volunteer Service Cancellation - Upon making a properly documented 

written request to the School, I am entitled to have up to 70 percent of the 

original principal loan amount of this loan canceled for qualifying service 

performed after the enrollment period covered by the loan as:  a volunteer 

under the Peace Corps Act;  a volunteer under the Domestic Volunteer 

Service Act of 1973 (ACTION programs).

Cancellation Rate - For each completed year of service under the 

Volunteer Service Cancellation provision, a portion of this loan will be 

canceled at the following rates:

 15 percent of the original principal loan amount for each of the first and 

second 12-month periods of service; and  20 percent of the original 

principal loan amount for each of the third and fourth 12-month periods of 

service.

DISCHARGES - My obligation to repay this loan may be partially or 

totally discharged for the reasons specified in paragraphs A, B, C, and D 

below.

A. Death - In the event of my death, the School will discharge the total 

amount owed on this loan. 

B. Total and Permanent Disability - Upon making a properly documented 

written request to the U.S. Department of Education, the total amount owed 

on this loan may be discharged if the Department determines that I am 

totally and permanently disabled as defined in the Act and I meet certain 

other requirements.

C. School Closure - Under certain conditions, my total liability will be 

discharged, including refunding any amounts I have already paid on the 

loan, if I was unable to complete the program in which I was enrolled 

because my School closed.
Terms and Conditions (cont.)

Page 4 of 4

D. Bankruptcy - Under certain conditions, my loan may be discharged in 

bankruptcy. In order to discharge a loan in bankruptcy, I must prove undue 

hardship in an adversary proceeding before the bankruptcy court.

Disclosure of Information

STUDENT LOAN OMBUDSMAN - If I dispute the terms of my 

Federal Perkins Loan in writing to my School, and my School and I are 

unable to resolve the dispute, I may seek the assistance of the Department 

of Education’s Student Loan Ombudsman. The Student Loan 

Ombudsman will review and attempt to informally resolve the dispute.

Notice About Subsequent Loans Made Under This 

Master Promissory Note

This Note authorizes the School to disburse multiple loans 

during the multi-year term of this Note upon my request and upon 

the School's determination of my loan eligibility.

Subsequent loans may be made under this Note for the same or 

subsequent periods of enrollment at this School. The School, 

however, may, at its discretion, close this Note at any time and 

require me to sign a new Note for additional disbursements. I

understand that if my School chooses to make subsequent loans 

under this Note, no such loans will be made after the earliest of the 

following dates: (i) the date the School receives my written notice 

that no further loans may be disbursed under this Note; (ii) twelve 

months after the date of my signature on this Note if no 

disbursement is made during such twelve-month period; or (iii) ten 

years after the date of my signature on this Note, or the date the 

School receives this Note. 

Any amendment to the Act governs the terms of any loans 

disbursed on or after the effective date of such amendment, and such 

amended terms are hereby incorporated into this Note.

Important Notices

Privacy Act Notice

The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice be provided to you:

The authority for collecting the requested information from and about you is §461 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 

1087aa et seq.) and the authorities for collecting and using your Social Security Number (SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and 31 

U.S.C. 7701(b). Participating in the Federal Perkins Loan (Perkins) 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 Perkins Program, to permit the servicing of your loan(s), and, 

if it becomes necessary, to locate you and to collect and report on your loan(s) if your loan(s) become delinquent or in default. We also use your SSN as an 

account identifier and to permit you to access your account information electronically.

The information in your file may be disclosed, on a case by case basis or under a computer matching program, to third parties as authorized under routine uses 

in the appropriate systems of records notices. The routine uses of this information include, but are not limited to, its disclosure to federal, state, or local 

agencies, to private parties such as relatives, present and former employers, business and personal associates, to consumer reporting agencies, to financial and 

educational institutions, and to guaranty agencies in order to verify your identity, to determine your eligibility to receive a loan or a benefit on a loan, to permit 

the servicing or collection of your loan(s), to enforce the terms of the loan(s), to investigate possible fraud and to verify compliance with federal student 

financial aid program regulations, or to locate you if you become delinquent in your loan payments or if you default. To provide default rate calculations, 

disclosures may be made to guaranty agencies, to financial and educational institutions, or to state agencies. To provide financial aid history information, 

disclosures may be made to educational institutions. To assist program administrators with tracking refunds and cancellations, disclosures may be made to 

guaranty agencies, to financial and educational institutions, or to federal or state agencies. To provide a standardized method for educational institutions 

efficiently to submit student enrollment status, disclosures may be made to guaranty agencies or to financial and educational institutions. To counsel you in 

repayment efforts, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal, state, or local agencies. 

In the event of litigation, we may send records to the Department of Justice, a court, adjudicative body, counsel, party, or witness if the disclosure is relevant 

and necessary to the litigation. If this information, either alone or with other information, indicates a potential violation of law, we may send it to the 

appropriate authority for action. We may send information to members of Congress if you ask them to help you with federal student aid questions. In

circumstances involving employment complaints, grievances, or disciplinary actions, we may disclose relevant records to adjudicate or investigate the issues. 

If provided for by a collective bargaining agreement, we may disclose records to a labor organization recognized under 5 U.S.C. Chapter 71. Disclosures may 

be made to our contractors for the purpose of performing any programmatic function that requires disclosure of records. Before making any such disclosure, 

we will require the contractor to maintain Privacy Act safeguards. Disclosures may also be made to qualified researchers under Privacy Act safeguards.

Financial Privacy Act Notice

Under the Right to Financial Privacy Act of 1978 (12 U.S.C. 3401-3421), the U.S. Department of Education will have access to financial records in your 

student loan file maintained by the lender in compliance with the administration of the Federal Perkins Loan Program.

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 

currently valid OMB control number. The valid OMB control number for this information collection is 1845-0074. Public reporting burden for this collection 

of information is estimated to average 30 minutes per response, including the 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 or 

retain benefit (Higher Education Act of 1965, as amended (20 U.S.C. 1087dd)). If you have any comments or concerns regarding the status of your 

individual submission of this form, please contact your lender directly. :