### 1 **FFEL CONSOLIDATION LOAN REBATE FEE REPORT and REMITTANCE FORM**  **Collection Type**

**– CLRF**  1. Lender ID: **8** __ __ __ __ __ 2. Servicer ID: **7** __ __ __ __ __ (Optional) 3. Reporting Period: __ __ / __ __ __ __

(MM) (YYYY) 

### 4. **Consolidation Loans Subject to the 1.05% fee; applicable rate: 0**  **0 0**  **8 7**  **5 0**  5. Number of Loans: __ __ __ **,** __ __ __ **,** __ __ __ 6. End
- of

- Month Principal Balance: $ __ __ __ **,** __ __ __ **,** __ __ __ **,** __ __ __ **.** __ __ 7. EOM Accrued Unpaid Interest Balance: $ __ __ __ **,** __ __ __ **,** __ __ __ **,** __ __ __ **.** __ __ 

### 8. **Consolidation Loans Subject to the 0.62% fee, applicable rate:**  **0 0**  **0 5**  **1 6**  **7** 9. Number of Loans: __ __ __ **,** __ __ __ **,** __ __ __ 10. End
- of

- Month Principal Balance: $ __ __ __ **,** __ __ __ **,** __ __ __ **,** __ __ __ **.** __ __ 11. EOM Accrued U npaid Interest Balance: $ __ __ __ **,** __ __ __ **,** __ __ __ **,** __ __ __ **.** __ __

12. **Total Consolidation Loan Rebate Fee** : $ __ __ __ **,** __ __ __ **,** __ __ __ **.** __ __ 13. Lender’s Check Number: __ __ __ __ __ __ __ __ __ __ __ __ 14. Lender Name: _________________________________________________________________ 15. Signature: _________________________________ 16. Date: ____________________ 17. Typed or Printed Name & Title: _______________________________________

____________ 18. Contact Name & Phone #: ________________________________________________________ ED Form 4
- 619 OMB No.: 1845
- 0046 Expiration Date: 0 4 / 30 /201 4

### 2 

### Consolidation Loan Rebate Fee Report

**Instructions Where to Submit:**  Ma il this completed Consoli dation Loan Rebate Fee Report and a check made payable to the "U.S. Department of Education," with a notation for, and in the amount of, the Fee to: U.S. Depart ment of Edu ca tion, P. O. Box 979066, St. Louis, MO 63197
- 9000 If you wish to pay the Fee by Automated Clearing House (ACH) instead of by check, call the U. S. Depart
ment of Education at (202) 377
- 3324/3322 for further instructions. The words "your" and "you" in these instruc tions refer to the lending insti tu tion for which this Consolidation Loan Rebate Fee Report is being prepared, or the per son at the institution preparing the report. **Applicability:** This Consolidation Loan Rebate Fee Report is used to report to the U.S. De part ment of Educa tion (ED) the Fe deral Con soli dation Loan Interest Pay ment Rebate Fee authorized by sub section 428C(f) of the Higher Education Act of 1965, as amended. A servicer providing loan ser vic es to sev eral dif

fer ent lenders must submit a separate Consolidation Loan Reba te Fee Report for each lender that it ser vices. Help on com

pleting this Con sol idation Loan Rebate Fee Report and on correcting or adjusting prior Reports can be obtained from ED by calling (202) 377
- 3324/3322. **NOTE** : A lender holding one or more Fede ral Consolidation Loans at the end of the month must submit a payment for the Consolidation Loan Rebate Fee within 30 days of the end of the month for which the Fee is calculated. **Form Preparation:** Submit the Consolidation Loan Rebate Fee Report using a photocopy of the front page of this form, or by typing or computer generating a facsimile of the front page of this form. If a fac sim
ile is pro duced, include the form title, the ED form number, and all material in the boxes on the front page of this fo rm. The fac simile must be produced on 81⁄2 x 11 inch plain white paper, and all items must be arranged in the same order as on the form. The dollar symbols ($) must be included, but the lines outlining the boxes and the underlines for each item may be omi tted. The instructions for this form may also be omitted. ED ma y reject a fac sim ile that does not meet these criteria. **Fee Calculation:** The Federal Consolidation Loan Interest Payment Rebate Fee is calculated and paid monthly to ED. It is equal on a monthly basis to 0.0875 percent of the unpaid balance of principal and the accrued unpaid interest on all Fed eral Consolidation Loans disbursed after October 1, 1993, and held by the lender on the last day of the month. (This is equal to an an nual ized rate of 1.05 percent.) Except for loans based on applications received during the period from October 1, 1998 through January 31, 1999, inclusive , for which the rebate is equal on a monthly basis to .05167 percent of the unpaid balance of principal and t he accrued unpaid interest. (This is equal to an annualized rate of 0.62 percent. ) Use the item
- by
- item instruct
ions in the fol low ing paragraphs to calculate the Fee and to complete the Consolida tion Loan Rebate Fee Report on the front page of this f orm. **1. Lender ID:** Enter your six
- digit lender identification number (LID). The “8” has been pre
- filled for you. **2. Servicer ID:** Enter your six
- digit servicer identification number, if applicable. The “7” has been pre
filled for you. **3. Reportin g Period:**  Enter the date of the last day of the month of the reporting period for which this Consolida tion Loan Rebate Fee Re port is being submitted. Enter the date in a "month/year" for mat. Enter the month as two digits. Enter the year as four digi ts. For the purpose of the Consolida tion Lo an Rebate Fee Report, a month is always a calendar month, starting on the first of the month and ending on the last day (the 30th or 31st, except for February). A calendar month reporting cycle must be used fo r the Consolidation Loan Rebate Fee Report even if you use a different reporting cycle (e.g. from the 26th day of one month to the 25th day of the following month) for internal or other reporting purposes. **4. Applicable rate for Consolidation Loans Subje ct to the 1.**  **05% fee:** This field has been pre
- filled for you.

### 3

**5. Number of Loans:** Enter the number of loans subject to the 1.05% fee used to calculate the Consolidation Lo an Rebate Fee. To determine this number, review all Federal Consolidation Loa ns held by you at the end of the month and identify the loans that were dis bursed on or after October 1, 1993, except for loans based on applications received during the period from October 1, 1998 through January 31, 1999, inclusive which are subject to the 0.62% fee . Include a loan even if you were not the orig i nating lender, you only pur chased it at a later date. In clude all loans eligible for insur ance, even if an insurance claim has been filed, but not paid, as of close of busi ness on the las t day of the month. **6. End -**  **of**

**- Month Principal Balance:**  Enter the Principal Balance used to determine the Consolidation Loan Rebate Fee. For all Federal Consolidation Loans meet ing the re quire ments in item 5, Number of Loans, determine the unpaid p rincipal bal ance at the end of the day on the last day of the month. Payments re ceived from bor rowers on the last day of the month should be credited prior to deter mining the unpaid prin cipal balance. Add the un

paid principal balances for all loans to determine the End
- of
- Month Principal Bal ance. You may round this total to the nearest dollar if desired. **7. End -**  **of**

**- Month Accrued Unpaid Interest Balance:**  Enter the End
- of
- Month Accrued Unpaid Interest Balance used to determine the Consolidation Lo an Rebate Fee. For each loan for which an End
- of
- Month Principal Balance (see item 6) was determined, determine its accrued unpaid interest bal ance at the end of the day on the last day of the month. Payments re ceived from bor row ers or ED on the last day of the month should be credited prior to determin ing the accrued unpaid interest bal ance. Add the accrued unpaid interest balances for all loans to determine the End
- of
- Month Accrued Unpaid Interest Balance. You may round this total to the nearest dollar if desired. **(Items 8 through 11**

– Repeat the instructions for Items 4 through 7, as they apply to Consolidation loans based on applications received during the period from October 1, 1998 through January 31,1999, inclusive, which are subject to th e 0.62% fee.) **12. Consolidation Loan Rebate Fee:** Enter the amount of the Federal Consolidation Loan Interest Payment Rebate Fee being paid at the time this report is submitted. To determine the amount of the Fee for the month, add the End
- of
- Month Pri ncipal Balance (see item 6) to the End
- of
- Month Ac crued Interest Balance (see item 7). Multiply this sum by 0.0875 percent (that is, .0008750). To this amount, add the End
of
- Month Principal Balance (see item 10) to the End
- of
- Month Accrued Interest Bal ance (see item 11) and then multiplied by .05167 percent (that is, .0005167). Round the resulting product to the nearest dollar if desired. Prepare a check for this amount made out to the "U.S. De part ment of Educa tion," and with the notation "Consolid a tion Loan Rebate Fee." (Refer to the "Where to Sub mit" par agraph at the beginning of the second page of this form for mailing instructions.) Please make sure that the amount reported in this item is the same as the amount of the check being submitte d. **13. Lender’s Check Number:**  Enter the number of your check. **14. Lender Name:** Enter the name of the lender that holds the Federal Consolidation Loans reported in the Consolidation Loan Rebate Fee Report. **15. Signature:** Read the certification stat ement and sign the form in ink . Forms signed with signature stamps and unsigned forms will be returned for a valid signature. **16. Date:** Enter the date the form is signed. **17. Typed Name & Title:** Type or print (do not write) the name and title of the official signing the form. **18. Contact Name & Phone #:** Print the name and the telephone number (including area code) of the person who can answer questions from ED about the holder's Federal Consolida tion Loan portfolio and about this Consolidation Lo an Rebate Fee Report. This person may be a representative of the servicer, or representative of the lending institution holding the loans. **Reporting Burden:** According to the Paperwork Reduction Act of 1995, no persons are required to respond to a coll ection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is es timated to average 1 hour per response, including time for reviewing instructions, searching existing data so urces, 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 (20USC 1078
- 3 and Pub. Law 103
- 66
- 4046). Send comments reg arding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210
- 4537 or email I CDocketMgr@ed.gov and referenc e the OMB Control Number 1845
- 0046. **If you have comments or concerns regarding the status of your individual submission of this form, write directly to U.S. Dept. of Education, 830 F**  **irst Street, N.E., 5**  **th Floor** 

**– Lender Reporting, Washington, D.C. 20202**  **.**

### 4 **Warning:** Although the law does not explicitly state that this information be reported, such reporting is necessary to implement the re quired monthly payments of the Consolidation Loan Rebate Fee (CLRF). Failure to report would be the basis for the i nitiation of an action to limit, suspend or terminate the lender's participation in the Federal Family Education Loan Programs pursuant to 20 U.S.C. Sections 1080, 10 82, 1085 and 1094. Also, any person who know ing ly and willfully destroys or conceals an y record relating to the provision of assistance under Title IV of the Higher Education Act of 1965, as amended, or attempts to so destroy or conceal with intent to defraud the United States or to preven t the United States from enforcing any right obtained by subrogation under Part B of Title I V, shall upon conviction thereof, be fined not more than $20,000 or imprisoned not more than 5 years, or both, under the provisions of 20 U.S.C. 1097.