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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 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: 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. Interest will accrue on your unsubsidized loan(s)

during deferment. You may pay the interest that 

accrues on your unsubsidized 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 section.

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 

or 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 – Skip to Sections 3 and 4.

No – Continue to Item 6.

6. Are you a full time officer in the Commissioned Corps 

of the Public Health Service?

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

SECTION 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 eligible 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 information requested below, including military identification or orders, as appropriate.

17. Did the 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 loan principal or interest during my deferment; (2) My 

deferment will begin on the date the public service that qualifies for the deferment began, as certified by the authorized 

official; (3) My 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) Maximum 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) 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 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 notify my loan holder 

immediately 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: ___ ___ - ___ ___ - ___ ___ ___ ___
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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 request 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 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 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 ACTION 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 eligible.

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.

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 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 

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 
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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 

1845-0011. 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).