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 SERV

MANDATORY FORBEARANCE REQUEST

MEDICAL OR DENTAL INTERNSHIP/RESIDENCY, NATIONAL GUARD DUTY, OR 

DEPARTMENT OF DEFENSE LOAN REPAYMENT PROGRAM

William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family 

Education Loan (FFEL) Program

OMB No. 1845-0018

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 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

Telephone – Primary

Telephone – Alternate

E-mail (optional)

___ ___ ___ - ___ ___ - ___ ___ ___ ___

___________________________________________

___________________________________________

________________________ , _______ __________

( ___________ ) ___________ - _________________

( ___________ ) ___________ - _________________

___________________________________________

SECTION 2: FORBEARANCE ELIGIBILITY

This forbearance request form covers three different forbearances. Carefully review the information for each 

forbearance type to determine whether you qualify for that forbearance.

1. Check the type of forbearance you would like to 

receive:

Stop making payments – Continue to Item 2.

Make smaller payments in the amount of 

$____________ per month – Skip to Item 3.

2. Interest will accrue on your loan(s) during 

forbearance. You may pay the interest that accrues on 

your these loan(s) during forbearance. If you do not 

pay this interest, it will capitalize. Do you wish to make 

interest payments on your loan(s) during forbearance?

Yes – Continue to Item 3.

No – Continue to Item 3.

3. You may receive this forbearance in 12-month 

increments. Would you like this forbearance end 

earlier?

Yes – Continue to Item 4.

No – Skip to Item 5, 10, or 16.

4. Provide the date on which you want the forbearance 

to end and then continue to Item 5, 10, or 16:

___ ___ - ___ ___ - ___ ___ ___ ___

PART A. MEDICAL OR DENTIAL INTERNSHIP/RESIDENCY

You only qualify for this forbearance if you do not qualify 

for a medical or dental internship/residency deferment.

5. Have you been accepted to an internship/residency 

program?

Yes – Continue to Item 6.

No – You are not eligible this forbearance.

6. Did your program require, as a condition of admission, 

that you have a bachelor’s degree from an institution 

of higher education?

Yes – Continue to Item 7.

No – You are not eligible this forbearance.

7. Is your internship/residency program a program in 

which you will receive training under supervision?

Yes – Continue to Item 8.

No – You are not eligible this forbearance.

8. Will completion of this program lead to a degree or 

certificate awarded by an institution of higher 

education, a hospital, or a health care facility that 

offers postgraduate training?

Yes – Have an authorized official complete Section 

3 and then complete Section 4

No – Continue to Item 9.
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Borrower Name: ______________________________ Borrower SSN: ___ ___ ___ - ___ ___ - ___ ___ ___ ___

SECTION 2: FORBEARANCE ELIGIBILITY (CONTINUED)

9. Will completion of the program be required by you 

can begin professional practice or service?

Yes – Have an authorized official complete Section 

3 and then complete Section 4. In addition, you 

must attach a separate statement form the 

appropriate state licensing agency certifying this 

requirement.

No – You are not eligible this forbearance.

PART B. NATIONAL GUARD DUTY

You only qualify for this forbearance if you do not qualify 

for a military service deferment.

10. Are you a member of the National Guard?

Yes – Continue to Item 11.

No – You are not eligible this forbearance.

11. Are you engaged in active State duty under which a 

governor activated you based on state statute or 

policy?

Yes – Continue to Item 12.

No – Skip to Item 13.

12. Is your service being paid for with State funds?

Yes – Skip to Item 15.

No – Continue to Item 13.

13. Are you engaged in active State duty under which a 

governor activated you with the approval of the 

President or the U.S. Secretary of Defense?

Yes – Continue to Item 14.

No – You are not eligible for this forbearance.

14. Is your service being paid for with Federal funds?

Yes – Continue to Item 15.

No – You are not eligible for this forbearance.

15. Were you activated not more than 6 months after the 

last date on which you were enrolled in school at least 

half time?

Yes – Have an authorized official complete Section 

3 and then complete Section 4.

No – You are not eligible for this forbearance.

PART C. DEPARTMENT OF DEFENSE LOAN REPAYMENT 

PROGRAM

16. Are you performing service that qualifies you for 

partial repayment of your loan(s) under the 

Department of Defense Loan Repayment Program 

authorized under 10 U.S.C. 2171?

Yes – Have an authorized official complete Section 

3 and then complete Section 4.

No – You are not eligible for this forbearance.

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, or, for the National Guard forbearance, a copy of the 

borrower’s orders.

17. Did the borrower select “yes” in Item 8, 9, 15, or 16?

Yes – Complete Items 18 through 26.

No – Do not complete this section.

18. The program/service begins/began on:

___ ___ - ___ ___ - ___ ___ ___ ___

19. The program/service is expected to end/ended on:

___ ___ - ___ ___ - ___ ___ ___ ___

I certify, to the best of my knowledge and belief, that: 

 The borrower named above is/was engaged in the service indicated in Section 2;

 That the borrower and the service meet all conditions indicated by the borrower’s responses in Section 2; and

 That the information that I have provided in Section 3 is accurate.

20. Name of Institution/Organization: ___________________________________________________________________

21. Address:_____________________________________

22. Name/Title:__________________________________

23. Signature:____________________________________

24. City, State, Zip Code:______________ , ____ _______

25. Telephone: ( ________ ) ________ - ______________

26. Date: ___ ___ - ___ ___ - ___ ___ ___ ___
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Borrower Name: ______________________________ Borrower SSN: ___ ___ ___ - ___ ___ - ___ ___ ___ ___

SECTION 4: BORROWER REQUEST UNDERSTANDINGS CERTIFICATIONS, AND AUTHORIZATION

I request a forbearance based on my service, as indicated in Section 2. If I am eligible for a deferment based on my 

service, I request that my loan hold grant me a deferment based on that service.

I understand that:

1. I am not required to make payments of loan principal or interest during my forbearance.

2. My forbearance will begin on the date the program or service that qualifies for the forbearance began, as 

certified by the authorized official.

3. My forbearance will end on the earlier of the date I am no longer eligible for the forbearance, 12 months from 

the date specified in Item 18, or the date I indicated in Item 4.

4. My forbearance will only be granted in 12-month increments and I must reapply for the forbearance if I continue 

to meet the eligibility requirements and want to extend my forbearance.

5. If my forbearance 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 forbearance request. Interest that accrues during this forbearance will not be capitalized.

I certify that: 

1. The information 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 forbearance status.

3. I will notify my loan holder immediately when my qualification for the forbearance ends.

4. I have read, understand, and meet the eligibility requires of the forbearance 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 telephone dialing equipment or artificial or 

prerecorded voice or text messages.

Borrower’s Signature: _____________________________________________ Date: ___ ___ - ___ ___ - ___ ___ ___ ___

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. An authorized official must either complete Section 4 or attach the organization’s own signed certification 

listing the required information. 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, contact 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 7: WHERE TO SEND THE COMPLETED FORM

Return the completed form to: If you need help completing this form, call:
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SECTION 6: DEFINITIONS

An authorized official is an internship/residency 

program official (for medical and dental internships and 

residencies); or an authorized official from the 

Department of Defense (the Loan Repayment Program); 

or commanding or personnel officer (for National Guard 

State Duty)

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 quarterly 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 

the deferment, and 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 Subsidized 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 holder 

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 holder 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.

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 Subsidized) 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.
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SECTION 8: 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 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 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 caseby-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 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. 

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 

1845-0018. Public reporting burden for this collection of 

information is estimated to average 15 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 682.211 or 685.205. 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).