What is a Preauthorized Debit

Account?

A Preauthorized Debit Account (PDA) is an 

account that gives your bank the authority to 

automatically deduct your defaulted Federal 

education debt payments from your 

checking/savings account.

What are the benefits?

With PDA, your payments will always be made 

on time, you will save on postage fees, and you 

can choose a payment schedule that best suits

your financial budget while repaying your 

student aid debt.

How do I establish an account?

To establish an account, complete the 

Preauthorized Debit Application attached to 

this brochure. Then mail it to the address at 

the bottom of the application, along with a 

blank check or savings account authorization 

voucher on which you have written “VOID.” 

After your bank starts deducting your 

payments, an itemization of your defaulted 

Federal education debt transactions will 

appear on your bank statement.

What amount will be debited from my 

account?

On the application, please indicate whether 

you want payments debited weekly, biweekly 

(once every two weeks), or monthly. The total 

amount deducted during a given month must 

be equal to or greater than the amount 

designated on your original repayment 

agreement, if a repayment agreement has 

been established. 

What if I want to cancel my PDA service?

To cancel your PDA service, just call the U.S. 

Department of Education’s Default Resolution 

Group at 1-800-621-3115. After cancellation, it 

may take seven (7) days to discontinue the 

electronic debiting service and there may be 

one more automatic payment deduction from 

your checking or savings account.

PLEASE NOTE:

 Your bank name, voided check or 

savings account voucher, and your 

bank’s routing number are required to 

establish your Preauthorized Debit 

Account. Your personal information 

will be kept confidential.

 Make a copy of the completed 

application for your records, or enter 

the information below and keep this 

page: 

Bank Name: ___________________________

Checking Account #: ____________________

Savings Account #: _____________________

Routing Number: 

Deduct payments of $___________ from my 

account. (The amount entered is the amount that will 

be debited weekly, biweekly or monthly, as indicated 

below.)

Weekly Circle a day: M T W Th F

Biweekly Enter start date from 1-28: ____

Monthly Enter start date from 1-28: ____

(Your payment will be debited on the specific day or date 

you enter.)

Date Signed:________________________

* * *

To learn more about PDA, go to:

www.myeddebt.com

PREAUTHORIZED DEBIT APPLICATION

Mail in this portion . . .

Defaulted Federal Education Debt Account Number (this 

number appears on your monthly statement):

I, ____________________________________ 

Applicant’s Name – (please print)

authorize my bank to deduct my defaulted Federal 

education debt payments automatically from the account 

designated below.

I understand that I must make regular monthly 

payments until I am notified that my Preauthorized 

Debit Account Application has been processed. If at any 

time I decide to discontinue Preauthorized Debits, I will 

notify the U.S. Department of Education’s Default 

Resolution Group at 1-800-621-3115.

Bank Name: ___________________________________

Checking Account #: _____________________________

Savings Account #: ______________________________

Routing Number: 

Deduct payments of $___________ from my account.

(The amount entered is the amount that will be debited 

weekly, biweekly or monthly, as indicated below.)

Weekly Circle a day: M T W Th F

Biweekly Enter start date from 1-28: ______

Monthly Enter start date from 1-28: ______

(Your payment will be debited on the specific day or date 

you enter.)

SSN: _________________________________________

______________________________ ___________

Applicant’s Signature Date

Daytime Phone: (_______) _______________________

Return this Application with voided check or savings 

account voucher with routing number to:

PREAUTHORIZED DEBIT PROGRAM

P.O. BOX 4139

GREENVILLE, TX 75403-4139

60-DAY CLEARANCE DRAFT 
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 are §428(b)(2)(A) et seq., §451 et seq., and/or §461 et 

seq. of the Higher Education Act (HEA) of 1965, as amended (20 

U.S.C. 1078(b)(2)(A) et seq., 20 U.S.C. 1087a et seq., and/or 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 Family Education Loan (FFEL) Program, William D. 

Ford Federal Direct Loan (Direct Loan) Program, and 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 FFEL Program, Direct Loan Program, and/or 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.

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 

1845-0025. Public reporting burden for this collection of 

information is estimated to average 0.083 hours (5 minutes) per 

response, including time for reviewing instructions, searching 

existing data resources, 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 or retain a benefit (U.S. Code 15 USC 1601 

Consumer Credit Protection Act). If you have any comments or 

concerns regarding the status of your individual submission of 

this Preauthorized Debit Application, write directly to:

U.S. Department of Education

Preauthorized Debit Program

P.O. Box 4139

Greenville, TX 75403-4139

60-DAY CLEARANCE DRAFT

OMB No. 1845-0025

Form Approved

Exp. Date xx/xx/xxxx