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## PARENTAL LEAVE / WORKING MOTHER DEFERMENT **William D .**  **Ford Federal Direct Loan (Direct Loan) Program / Federal Family**  **Education Loan (FFEL) Program** OMB No . 1845-0011 DRAFT FORM Exp . Date XX/XX/XXXX **WARNING:** Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying document is subject to penalt ies 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 Telephone – Primary Telephone – Alternate E- mail (optional) ___ ___ ___ - ___ ___ - ___ ___ ___ ___

_____________________________ _______ _______

____________________________________ _______

________________________ , _______ __________ (

____ ____ ___ )

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_ _ ___ _________ (

_ ___ _ _ _____ )

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___________________________________________ **SECTION 2: DEFERMENT**  **ELIGIBILITY** This deferment request form covers two different deferments . Carefully review the information for each deferment type to determine whether you qualify for that deferment . Before completing Section 2, read Section 8 . **1.** Interest that accrues on unsubsidized loans during deferment will capitalize at the end of the deferment. Would you like to make interest payments on your unsubsidized loans during the deferment? Yes – Continue to Item 2 . No – Continue to Item 2 . **PART A. PARENTAL LEAVE DEFERMENT**  Maximum eligibility is 6 months per occurrence. **2.** Are you pregnant? Yes – Provide a statement from your physician documenting your pregnancy. Skip to Item 5 . No – Continue to Item 3 . **3.** Are you caring for your newborn child (a child less than 6 months in age) ? Yes – Provide a copy of your child’s birth certificate. Skip to Item 5 . No – Continue to Item 4 . **4.** Are you caring for your newly adopted child? Yes – Provide a statement from the adoption agency documenting the child’s placement and placement date. Continue to Item 5 . No – You are not eligible for this deferment . **5.** Will you be working or attending school during the period for whic h you are requesting a deferment? Yes – You are not eligible for this deferment . No – Continue to Item 6 . **6.** Were you e nrolled in school at least half time at any point during preceding 6 months? Yes – Continue to Item 7 . No – You are not eligible for this deferment . **7.** When would you like your deferment to begin?

___ ___ - ___ ___ - ___ ___ ___ ___ Have an authorized official of your school complete Section 3 . Then complete Section 4. **PART B. WORKING MOTHER DEFERMENT**  Maximum eligibility is 12 months. **8.** Did you enter/re-enter the workforce in the last year? Yes – Continue to Item 9 . No – You are not eligible this deferment . **9.** Are you working full time and earning not more than $1 per hour above the federal minimum wage? Yes – Provide a copy of a pay stub that shows your rate of pay. Continue to Item 10 . No – You are not eligible this deferment . **10.** Are you the mother of a preschool -age child who has not yet enrolled in the first grade or a higher grade in an elementary school? Yes – Provide a copy of your child’s birth certificate. Continue to Item 11 . No – You are not eligible this deferment . **11.** When would you like your deferment to begin?

___ ___ - ___ ___ - ___ ___ ___ ___ Skip to Section 4.Page 2 of 5 

### Borrower Name: ______________________________ Borrower SSN:

**___ ___**  **___ -**  **___ ___**  **- ___**  **___ ___**  **___ SECTION**  **3 :**  **AUTHORIZED OFFICIAL’S CERTIFICATION Note: As an alternative to completing this section, you may**  **attach separate documentation from an authorized**  **official that includes all of the information requested below**. **12.** Did the borrower select “yes” in Item 6 ? Yes – Complete Items 13 - 21 . No – Do not co mplete this section . **13.** When was the borrower last enrolled at least half time?

___ ___ - ___ ___ - ___ ___ ___ ___ **I certify, to the best of my knowledge and belief, that :**   The borrower named above was enrolled as indicated in Section 2;  That the information that I have provided in Section 3 is accurate. **14.** Name of Institution:

______ ______________________ **15.** Address:_____________________________________ **16.** Name/Title:_________________________________

_ **17.** Signature:____________________________________ **18.** OPEID (if applicable): __________________________ **19.** City, State, Zip Code:

______________ , ____ _______ **20.** Telephone: (

________ )

________ - ________ _ _____ **21.** Date:

___ ___ - ___ ___ - ___ ___ ___ ___ **SECTION 4**  **: BORROWER**  **REQUEST UNDERSTANDINGS CERTIFICATIONS, AND AUTHORIZATION**  **I request** to defer my loans while I am on parental leave or am a working mother, as indicated in Section 2. **I understand that: 1.**  I am not required to make payments of loa n principal o r interest during my deferment. **2.** My deferment will begin on the date the condition that qualifies me for the deferment began. **3.** My deferment will end on the earlier of the date that the condition that establishes my deferment eligibility ends or the date on which I exhaust my maximum cumulative eligibility ends, as explained in Section 7. **4.** If I am applying for the Parental Leave Deferment and I am in my grace period, I agree to waive up to 1 month of my grace period so that my deferment begins within 6 months of the date I was last enrolled in school at least half time. **5.** If my deferment does not cover all my past due payments, my loan holder may grant a forbearance for all payments due before the begin date of my deferment. **6.** My loan holder may grant a forbearance for up to 60 days for the collection and processing of documentation related to my deferment request. Interest that accrues during this forbearance will not be capitalized. **I certify that: 1.**  The info rmation I have provided on this form is true and correct. **2.** I will provide additional documentation to my loan holder, as required, to support my deferment status. **3.** I will not ify my loan holder immediate ly when my qualification for the deferment ends. **4.** I have read, understand, and meet the eligibility requires of the deferment for which I have applied. **I authorize** the entity to which I submit this request (i.e., the school, the lender, the guaranty agency, the U.S. Department of education, and their respective agents and 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 using automated tel ephone dialing equipment or artificial or prerecorded voice or text messages. **Borrower’s Signature** : _____________________________________________ **Date** :

___ ___ - ___ ___ - ___ ___ ___ ___Page 3 of 5 **SECTION 5 :**  **INSTRUCTIONS** Type or print using dark ink. Enter dates as month -day-year (mm -dd -yyyy). Use only numbers. Example: March 14, 2015 = 03- 14-2015. Include your name an account number on any documentation that you are required to submit with this form. If you need help completing this form, co ntact your loan holder. If you want to apply for a deferment on loans that are held by different loan holders, you must submit a separate deferment request to each loan holder. **SECTION 6 :**  **DEFINITIONS** An **authorized official** who may complete Section 4 (for a Parental Leave Deferment) is an authorized official from the school where you were enrolled at least half time within the 6- month period preceding this deferment. **Capitalization** is the addition of unpaid interest to the principal balance of your loan. As a result of capitalization, more interest may accrue over the life of the loan and the monthly payment amount may be higher. The chart below (Table 1) provides estimates, for a $15,000 unsubsidized loan balance at a 6.8% interest rate, of the monthly payments due following a 12- month deferment that started when the loan entered repayment. It compares the effects of paying the interest as it accrues, capitalizing the interest at the end of the deferment, and capitalizing interest qu arterly and at the end of the deferment. Please note that the U.S. Department of Education (the Department) and many other holders do not capitalize interest on a quarterly basis . The actual loan interest cost will depend on your interest rate, length of t he deferment, a nd frequency of capitalization. A **deferment** is a period during which you are entitled to postpone repayment of the principal balance of your loan(s). Interest does not accrue during a deferment on a Direct Subsidized Loan, a Direct Subsidize d Consolidation Loan, a subsidized Federal Stafford Loan, or, in some cases, the subsidized portion of a Federal Consolidation Loan (see Note). Interest does accrue during a deferment on a Direct Unsubsidized Loan, a Direct PLUS Loan, a Direct Unsubsidized Consolidation Loan, an unsubsidized Federal Stafford Loan, a Federal PLUS Loan, or a Federal SLS Loan. **Note:** Interest does not accrue on a Federal Consolidation Loan during a deferment only if: **(1)** the application for the loan was received by your loan ho lder on or after January 1, 1993, but before August 10, 1993; **(2)** the application was received by your loan holder on or after August 10, 1993, and the loan includes **only** subsidized Federal Stafford Loans; or **(3)** the application was received by your loan h older on or after November 13, 1997, in which case interest does not accrue on the portion of the Federal Consolidation Loan that paid a subsidized Direct Loan or FFEL Program loan(s). The **Federal Family Education Loan (FFEL) Program**  includes Federal Stafford Loans, Federal PLUS Loans, Federal Consolidation Loans, and Federal Supplemental Loans for Students (SLS). A **forbearance** is a period during which you are permitted to temporarily postpone making payments, allowed an extension of time for making payments, or temporarily allowed to make smaller payments than scheduled. **Full -** **time employment** is defined as working at least 30 hours per week in a position expected to last at least 3 consecutive months. The **holder** of your Direct Loan Program loan(s) is the Department . The holder of your FFEL Program loan(s) may be a lender, guaranty agency, secondary market, or the Department. The **William D. Ford Federal Direct Loan (Direct Loan) Program**  includes Federal Direct Stafford/Ford (Direct Subs idized) Loans, Federal Direct Unsubsidized Stafford/Ford (Direct Unsubsidized) Loans, Federal Direct PLUS (Direct PLUS) Loans, and Federal Direct Consolidation (Direct Consolidation) Loans. **Table 1. Capitalization Chart**  **Treatment of Interest Accrued**  **During Deferment Loan**  **Amount Capitalized** 

**Interest Principal**  **Monthly Pmt.**  **Num.**

**Pmts. Total** 

**Repaid Total** 

**Interest Paid**  Interest is paid $15,000.00 $0.00 $15,000.00 $172.62 120 *$21,736.55 $6,730.66 Interest is capitalized at the end of deferment $15,000.00 $1,022.09 $16,022.09 $184.38 120 $22,125.94 $7,119.64 Interest is capitalized quarterly during deferment and at the end of deferment $15,000.00 $1,048.51 $16,048.51 $184.69 120 $22,162.41 $7,156.10

*Total amount repaid includes $1,022.09 of interest paid during the 12

- month period of deferment.Page 4 of 5 **SECTION 7**  **: WHERE TO SEND THE COMPLETED FORM** Return the completed form to : If you need help completing this form, call:

**SECTION 8**  **: ELIGIBILITY REQUIREMENTS**  For the **parental leave deferment**, you are only eligible if, in addition to meeting the criteria below, you answered “yes” in Items 2, 3, or 4, answered “no” to Item 5, and answered “yes” to Item 6 . For the **working mother deferment**, you are only eligible if, in addition to meeting the criteria below, you answered “yes” to Items 8 - 10 . You are only eligible if, in addition to meeting the criteria above, you:  Are a Direct Loan borrower who had an outstanding balance on a FFEL Program loan that was first disbursed before July 1, 1993 when you obtained your first Direct Loan; or  Are a FFEL Program borrower and had an outstanding balance on a FFEL Program loan tha t was first disbursed before July 1, 1993 when you received a FFEL Program loan on or after July 1, 1993 Your Federal Stafford and SLS Loans only eligible for the **working mother deferment** if your first FFEL Program loan was disbursed on or after July 1, 1987 and before July 1, 1993. The following types of loans are not eligible for these deferments:  Direct PLUS Loans  Direct PLUS Consolidation Loans  Federal PLUS Loans  Federal Consolidation Loans

**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 . and §451 et seq . of the Higher Education Act of 1965, as amended (20 U . S . C . 1071 et seq . and 20 U . S . C . 1087a et seq . ) and the authorities for collecting and using your Social Security Number (SSN) are §§428B(f) and 484(a)(4) of the HEA (20 U . S . C . 1078-2(f) and 1091(a)(4)) and 31 U . S . C . 7701(b) . Participating in the Federal Family Education Loan (FFEL) Program or the William D . Ford Federal Direct Loan (Direct Loan) Program and giving us your SSN are voluntary, but you must provide the requested information, including your SSN, to parti cipate . 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 forgivenes s) under the FFEL and/or Direct Loan Programs, 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 matching program, to third parties as authorized under routine uses in the appropri ate 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 loa n(s), to enforce the terms of the loan(s), to investigate possible fraud and to verify compliance with federal studentPage 5 of 5 financial aid program regulations, or to locate you if you become delinquent in your loan payments or if you default . To provide default rate calculations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to state agencies . To provide financial aid history information, disclosures may be made to educational institutions . To assist program administrators with tracking refunds and cancellations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal or state agencies . To provide a standardized method for educational institutions to efficiently submit stu dent enrollment statuses, disclosures may be made to guaranty agencies or to financial and educational institutions . To counsel you in repayment efforts, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal, state, or local agencies . In the event of litigation, we may send records to the Department of Justice, a court, adjudicative body, counsel, party, or witness if the disclosure is relevant and necessary to the litigation . If this information, either alo ne 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 u nder 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 1845-0011 . Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information . The obligation to respond to this collection is required to obtain a benefit in accordance with 34 CFR 682.210 or 685.204 . If you have comments or concerns regarding the status of your individual submission of this form, please contact your loan holder directly ( see Section 7 ) .