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**PUB** 

## PUBLIC SERVICE **DEFERMENT REQUEST 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 penalties th at 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: DEFERMENT**  **ELIGIBILITY** This deferment request form coverts four different deferments . Carefully review the information for each deferment type to determine whether you qualify for that deferment. Read Section 8 before completing Section 2 . **1.** I nterest will accrue on your unsubsidized loan(s) during deferment . You may pay the interest that accrues on your unsubsid ized loan(s) during deferment. Otherwise, it will capitalize. Do you wish to make interest payments on your unsubsidized loan(s) during deferment? Yes – Continue with the remainder of this se ction . No – Continue with the remainder of this section . **PART A. ARMED FORCES, PUBLIC HEALTH, AND NOAA**  **2.** Are you on active duty in the Armed Forces of the United States ? The Armed Forces include the Army, Navy Air Force, Marine Corps, or Coast Guard. Yes – Continue to Item 3 . No – Skip to Item 6 . **3.** Are you in a reserve component of the Armed Forces o r the National Guard? Yes – Continue to Item 4 . No – Skip to Item 6 . **4.** Are you serving full time for a period expected to last at least 1 year? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – Continue to Item 5 . **5.** Are you serving under an order for national mobilization? Yes – S kip to Section s 3 and 4 . No – Continue to Item 6 . **6.** Are you a full time officer in the Commissioned Corps of the Public Health Se rvice? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – Continue to Item 7 . **7.** Are you on active duty in the National Oceanic and Atmospheric Administration (NOAA)? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – You are not eligible for this deferment . **PART B. PEACE CORPS**  **8.** Are you in the Peace Corps? Yes – Continue to Item 9 . No – You are not eligible for this deferment . **9.** Have you agreed to serve for at least 1 year? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – You are not eligible for this deferment . **PART C. ACTION PROGRAMS 10.**  Are you a full -time, paid volunteer in the ACTION Programs? Yes – Continue to Item 11 . No – You are not eligible for this deferment . **11.** Have you agreed to serve for at least 1 year? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – You are not eligible for this deferment .Page 2 of 5 

### Borrower Name: ______________________________ Borrower SSN:

**___ ___**  **___ -**  **___ ___**  **- ___**  **___ ___**  **___ SE** **CTION 2: DEFERMENT**  **ELIGIBILITY (CONTINUED)**  **PART D. TAX -**  **EXEMPT ORGANIZATION 12.**  Are you serving full -time at an organization that is taxexempt under Section 501(c)(3) of the Internal Revenue Code? Yes – Continue to Item 13 . No – You are not eligible for this deferment . **13.** Do you assist low- income people and their communities in eliminating poverty and povertyrelated human, social, and environmental conditions? Yes – Continue to Item 14 . No – You are not eligible for this deferment . **14.** Do you earn more than the Federal minimum wage? Yes – You are not eligib le for this deferment . No – Continue to Item 15 . **15.** Do you engage in religious instruction, proselytizing, fund - raising to support religious activities, or conduct worship services as part of your duties? Yes – You are not eligible for this deferment . No – Continue to Item 16 . **16.** Have you agreed to serve for at least 1 year? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – You are not eligible for this deferment . **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 informa tion requested below, including military identification or orders, as appropriate.**  **17.** Did th e borrower select “yes” in Item 4 – 7, 9, 11, or 16 ?Yes – Complete Items 18 – 26 . No – Do not complete this section . **18.** The borrower’s service begins/began on :

___ ___ - ___ ___ - ___ ___ ___ ___ **19.** The borrower’s service is expected to end/ended on :

___ ___ - ___ ___ - ___ ___ ___ ___ **I certify, to the best of my knowledge and belief, that (1)**  the borrower and the service meet all conditions indicated by the borrower’s responses in Section 2 **(2)** the information that I have provided in Section 3 is accurate. **20.** Name of Organization :

____ ____________

__________________________________________________ __________ **21.** Address:_____________________________________ **22.** Name/Title:__________________________________ **23.** Signature:____________________________________ **24.** City, State, Zip Code:

______________ , ____ _______ **25.** Telephone: (

________ )

________ - ________ _ _____ **26.** Date:

___ ___ - ___ ___ - ___ ___ ___ ___ **SECTION 4**  **: BORROWER**  **REQUEST, UNDERSTANDINGS CERTIFICATIONS, AND AUTHORIZATION**  **I request** to defer my loans during my qualifying public service, as outlined in Sections 2 and 3. **I understand that (1)** I am not required to make payments of loa n principal o r interest during my deferment; **(2)** M y deferment will begin on the date the public service that qualifies for the deferment began , as certified by the authorized official; **(3)** M y deferment will end on the earlier of the date that I am no longer performing the public service, or the ending date as certified by the authorized official; **(4)** M aximum eligibility is 3 years; **( 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** **)** M y 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 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 deferment status; **(3)** I will not ify my loan holder immediate ly when my qualification for the deferment ends; and **(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 telephone 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, 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 reque st to each loan holder. **SECTION 6 :**  **DEFINITIONS** An **authorized official** who may complete Section 3 is your Commanding or Personnel Officer of the Armed Forces or an authorized official of the U.S . Public Health Service, Peace Corps, ACTION Programs, tax-exempt organization, or NOAA. **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 l oan 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, 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 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 Loa n. **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 n ot 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 Fe deral 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 Federa l 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.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 all deferments**, 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 who had an outstanding balance on a FFEL Program loan that was first disbursed before July 1, 1993 when you received a FFEL Program loan on or after July 1, 1993 For the **Armed Forces, Public Health, and NOAA deferment** , you are only eligible if you answer “yes” in Item 2, and, and appropriate Item 4, or if you answer “yes” in Item 6 or 7 . The maximum eligibility of 3 years is a combined limit for the Armed Forces, Public Heath, and NOAA deferment. For the **Peace Corps deferment** , you are only eligible if you answer “yes” in Items 8 and 9 . For the **AC TION Program**  **deferment**, you are only eligible if you answer “yes” in Items 10 and 11 . For the **Tax -**  **Exempt Organization deferment** , you are only eligible if you answer “yes” to Items 12 – 14, if you answer “no” to Item 15, and if you answer “yes” to Item 16 . For **all deferments**, your Federal Consolidation Loans are not e ligible. **For the NOAA deferment**, your Federal Stafford and SLS Loans are only eligible if:

 Your first FFEL Program loan was disbursed on or after July 1, 1987 and before July 1, 1993; or  You had an outstanding balance on a FFEL Program loan that was first disbursed on or after July 1, 1987 and before July 1, 1993 when you obtained a FFEL Program loan on or after July 1, 1993. **For the NOAA deferment**, Direct and Federal PLUS Loans and Direct PLUS Consolidation Loans are not eligible. Federal PLUS Loans are only eligible for the other deferments listed in Section 2 if the Federal PLUS Loan was first disbursed before August 13, 1983.

**SEC TION**  **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 th e 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 fo rgiveness) 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 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 ass ociates, to consumer reporting agencies, to financial and educational institutions, and toPage 5 of 5 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 a dministrators 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 su bmit 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 -0011 . Public reporting burden for this collection of information is estimated to average 1 0 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 ) .