### RPS 

# REPAYMENT PLAN SELECTION **: Standard Repayment Plan/Graduated Repayment Plan/Extended Repayment Plan**  **William D. Ford Federal Direct Loan (Direct Loan)**  **Program WARNING:**  Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying documents is subject to penalties that may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097. **SECTION 1: BORROWER IDENTIFICATION** Please enter or correct the following information. **Check this box if any of your information has changed.** SSN
- - Name Address City, State, Zip Code Telephone
– Primary ( ) Telephone
– Alternate ( ) E
- mail Address (Optional) **SECTION 2 : REPAYMENT PLAN**  **DESCRIPTIONS If**  **you choose...**  **...and you**  **have... ...** **your minimum**  **monthly payment will be...**  **...and your** 

**maximum repayment period**  **will be...**
...the Standard Repayment Plan... ...Direct Subsidized, Unsubsidized, or PLUS Loans... ...$50... ...10 years. ...Direct Consolidation Loans... ...$50... ...10
-30 years (see below)

. ...the Graduated Repayment Plan... ...Direct Subsidized, Unsubsidized, or PLUS Loans... ...monthly

interest... ...10 years. ...Direct Consolidation Loans... ...monthly

interest... ...10
-30 years (see below)

. ...the Extended Repayment Plan
– Fixed Payments... ...a ny type of Direct Loan... ...$50. ...25 years.
...the Extended Repayment Plan
– Graduated Payments... ...any type of Direct Loan... ...monthly

interest... ...25 years. **Maximum Repayment Period for**  **Direct Consolidation Loans**  **under Standard and Graduated Repayment Plan**  **If your Total Education Loan**  **Indebtedness is ...**  **...your Maximum**  **Repayment Period will be...**  At Least Less Than

$7,500 10 years $ 7,500 $10,000 12 years $10,000 $20,000 15 years $20,000 $40,000 20 years $40,000 $60,000 25 years $60,000 30 years **STANDARD REPAYMENT PLAN** Under this plan, you will pay a fixed amount each month over the course your maximum repayment period. This plan may result in lower total interest paid when compared to other plans. **GRADUATED REPAYMENT PLAN** Under this plan, your payments start out low and then increase every two years. No single payment under this plan will be more than three times greater than any other payment. Generally, the amount you will repay over the life of your loan will be higher under this plan than under the Standard Re payment Plan. This plan may be beneficial if your income is low now but is likely to steadily increase.
**EXTENDED REPAYMENT PLAN** You may choose this plan only if (1) you had no outstanding balance on a Direct Loan on October 7, 1998 or on the date you obtained a Direct Loan after that date, and (2) you owe more than $30,000 in outstanding Direct Loans. Under this plan, you have the option of making either fixed or graduated payments over your maximum repayment period
. If you elect graduated payments, your payments start out low and then increase every two years. Under either the fixed or graduated monthly payment option, the Extended Repayment Plan will give you a lower monthly payment on your non -consolidation loans than the Stan dard or Graduated Repayment Plans. However, b ecause of the longer repayment period, you will pay more interest over the life of your loan s . If you have a Direct Consolidation Loan and owe more than $30,000 but less than $40,000 in education l o ans, the Extended Repayment Plan will provide you with a longer repayment period than the Standard or Graduated Repayment Plans, but the total amount of interest you pay over the life of the loan may be more than under those plans. **SECTION 3 : REPAYMENT PLAN**  **REQUEST Check the box for the repayment plan that you wish to select:** 

Standard Repayment Graduated Repayment Extended Repayment
– Fixed Payments Extended Repayment
– Graduated Payments **Note** : If you want a repayment plan with a monthly payment amount that is based on your income, complete the Income

- Based/Pay As You Earn/Income

-Contingent Repayment Plan Request. If you have other loans that are not eligible for repayment under IBR, Pay As You Earn, or ICR plans (see below), you may select IBR, Pay As You Earn, or ICR for your eligible loans and repay your ineligible loans under a different plan. Check this box if you have some loans that you wish to repay unde r the repayment plan selected above because those loans are not eligible for the IBR plan, the Pay As You Earn plan , or the ICR plan. The following loans are not eligible to be repaid under the IBR, Pay As You Earn, and/or ICR plans:
 Direct PLUS Loans made to parents of dependent undergraduates : not eligible for IBR, Pay As You Earn , or ICR
.  Direct Consolidation Loans that repaid Direct or Federal PLUS Loan s made to parents of dependent undergraduates : not eligible for IBR or Pay As You Earn
.  Direct PLUS Consolidation Loans : not eligible for IBR, Pay As You Earn , or ICR **SECTION 4: BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATI ON**   **I understand that: (1)**  I must choose the same repayment plan for all of my Direct Loans, unless I want to repay my loans under the I ncome- Based Repayment (IBR) , Pay As You Earn, or Income Cont ingent Repayment (ICR) Plan a nd I have some loans that may not be repaid under those plans. In this case, I may select the IBR, Pay As You Earn, or ICR plan for the loans that are eligible for repayment under those plans by completing the IBR/Pay As You Earn/ ICR Plan Request, and may select a different repayment plan for the loans that may not be repaid under IBR, Pay As You Earn, or ICR. **(2)** If I am beginning repayment of my loans for the first time and I do not select a repayment plan, I will be placed on the Standard Repa yment Plan. **(3)** If I am delinquent in making payments under my current repayment plan at the time I request to change to a different plan, my servicer may grant me a forbearance to cover any payments that are overdue at the time I enter the repayment plan I selected in Section 3
. Unpaid interest that accrues during this forbearance period may be capitalized at the end of the forbearance period.  **I certify that (1)**  The information I have provided on this form is true and correct and **(2)** I have read and understand the repayment plan that I requested, as explained in Section 2
.  **I authorize** the U.S. Department of Education (and its agents or contractors) to contact me regarding my request or my loan(s), including repayment of my loan(s), at the number that I provide on this form or any future number that I provide for my cellular telephone or other wireless device usi ng automated telephone dialing equipme nt or artificial or prerecorded voice or text messages. **Borrower’s Signature Date**  OMB No. 1845
-0014 DRAFT Form Exp. Date xx/xx/xxxx**SECTION 5: INSTRUCTIONS FOR COMPLETING THE FORM**

Type or print using dark ink. Enter dates as month

-day

-year (mm

-dd

-yyyy ). Use only numbers. Example: January 31, 2012 = 01

-31
- 2012. If you need help completing this form, contact your federal loan servicer . If you want to apply for a repayment plan and your Direct Loans are serviced by different federal loan servicers, you mu st submit a separate repayment plan request to each loan servicer
. **Return the completed form and any required documentation t o the address shown in Section 7**  **. SECTION 6: SAMPLE PAYMENT AMOUNTS**  Below are two tables that provide examples of monthly payment amounts under the Standard, Graduated, and Extended repayment plan s . The figures provided in these tables a re estimates. Various factors, including your actual interest rate, the amount of your lo an debt, and whether you have u sed any of your rep ayment period, may cause your payment amount to differ from the monthly payment amounts shown in these tables. Your federal loa n servicer will provide you with the actual monthly payment amount after you select a repayment plan
. 

### Non **- Consolidation Loans**  Debt When Loan Enters Repayment Standard (10 years) Graduated (10 years) Extended

- Fixed (25 years) Extended

-Graduated (25 years) Payment Total Paid Minimum Payment Maximum

Payment Total Paid Payment Total Paid Minimum Payment Maximum

Payment Total Paid $10,000 $115 $13,810 $66 $19 9 $14,860

- - - - - $20,000 $230 $27,619 $133 $398 $29,720

- - - - - $30,000 $345 $41,429 $199 $598 $44,580

- - - - - $40,000 $460 $55,239 $266 $797 $59,439 $278 $83,289 $227 $397 $90,207 $50,000 $575 $69,048 $332 $996 $74,300 $347 $104,111 $283 $496 $112,762 $60,000 $690 $82,858 $398 $1,195 $89,160 $416 $124,933 $340 $595 $135,314 $70,000 $806 $96,667 $465 $1,393 $104,020 $486 $145,755 $397 $694 $157,865 $80,000 $921 $110,477 $531 $1,593 $118,880 $555 $166,577 $453 $793 $180,427 $90,000 $1,036 $124,287 $597 $1,791 $133,740 $625 $187,399 $510 $892 $202,980 $100,000 $1,151 $138,096 $664 $1,991 $148,600 $694 $208,222 $567 $992 $225,531 All payments above are calculated using a fixed interest rate of 6.8 percent. 

### Consolidation Loans
Debt When Loan Enters Repayment Standard (10

-30 years) Graduated (10

-30 years) Extended

- Fixed (25 years) Extended

-Graduated (25 years) Maximum Repayment Period Payment Total Paid Maximum

Repayment Period Minimum

Payment Maximum

Payment Total

Paid Payment Total Paid Minimum

Payment Maximum

Payment Total

Paid $10,000 15 years $97 $ 17,463 15 years $69 $1 63 $19,174

- - - - - $20,000 20 years $170 $40,899 20 years $138 $241 $44,420

- - - - - $30,000 20 years $256 $61,349 20 years $206 $3 62 $66,634

- - - - - $40,000 25 years $315 $ 94,614 25 years $275 $417 $101,515 $ 315 $94,614 $275 $417 $101,515 $50,000 25 years $394 $ 118,268 25 years $344 $5 21 $126,899 $ 394 $ 118,268 $344 $521 $126,899 $60,000 30 years $451 $ 162.274 30 years $413 $ 549 $166,145 $473 $141, 921 $413 $ 625 $152,280 $70,000 30 years $526 $ 189,319 30 years $481 $640 $193,841 $ 552 $165,575 $481 $730 $177,664 $80,000 30 years $601 $ 216,365 30 years $550 $732 $221,531 $ 631 $189,228 $550 $834 $203,046 $90,000 30 years $676 $ 243,410 30 years $619 $823 $249,228 $ 710 $212,882 $619 $938 $228,428 $100,000 30 years $751 $ 270,456 30 years $688 $915 $276,914 $ 789 $236,535 $ 688 $1,042 $253,806

All payments above are calculated using a fixed interest rate of 8.25 percent, which is the maximum interest rate on Direct Consolidation Loans.

**SECTION 7: WHERE TO SEND THE COMPLETED REPAYMENT PLAN**  **SELECTION** Return the completed form and any required documentation to: (If no address is shown, return to your federal loan servicer .) If you need help completing this form, call: (If no telephone number is shown, call your federal loan servicer .)**SEC TION 8** **: IMPORTANT NOTICE S**  **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 §451 et seq. of the Higher Education Act of 1965, as amended (20 U.S.C. 1087a 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 William D. Ford Federal Direct Loan (Direct Loan) Program and giving us your SS N 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 deter mine your eligibility to receive a loan or a benefit on a loan (such as a deferment, forbearance, discharge, or forgiveness) under the Direct Loan 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) becomes delinquent or defaults. We also use your SSN as an account identifier and to permit you to access your account information electronically. The information in your file may be disclosed, on a case

- by

-case basis or under a computer matc hing 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 su ch 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 regul ations, or to locate you if yo u become delinquent in your loan payments or if you default. To provide default rate calculations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to state agencies. To provide financial aid history information , disclosures may be made to educational institutions. To assist program administrators with tracking refunds and cancellations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal or state agencies. To provide a standardized method for educational institutions to efficiently submit student enrollment statuses, disclosures may be made to guaranty agencies or t o financial and educational institutions. To counsel you in repayment efforts, disclosures may b e 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 di sclosure 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, grieva nces, or disciplinary actions, we may disclose relevant records to adjudicate or investigate the issues. If provided for by a coll ective 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 perfo rming 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 m ade to qualified researchers under Privacy Act safeguards. **Paperwork Reduction Notice.** According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to avera ge 0. 167 hours ( 10 minutes) per response, including the time for reviewing instructions, searching existing data resources, gathering and maintaining the data needed, and completing and revi ewing the information collection. Individuals are obligated to re spond to this collection to obtain a benefit in accordance with 34 CFR 685.208 . Send comments regarding the burden estimate(s) or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Education, 400 Maryland Avenue, SW, Washington, DC 20210

-4537 or e
- mail ICDocketMgr@ed.gov and reference OMB Control Number 1845

-0014
. **Note: Please do not return the completed form to this address. If you have questions regarding the status of your indivi** **dual submission of this form, contact your federal**  **loan servicer**  **(see Section 7**  **).**