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## UNEMPLOYMENT **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 Maximum eligibility is 36 months for Direct Loan and FFEL Program borrowers except for FFEL Program borrowers**  **whose firs t FFEL Program loan was first disbursed**  **before July 1, 1993, whose maximum eligibility is 24 months.**  **1.** Interest that accrues on unsubsidized loans during deferment will capitalize at the end of the deferment. Would you like to make interest payments on your unsubsidized loans during the deferment? Yes – Continue to Item 2 . No – Continue to Item 2 . **2.** Are you receiving unemployment benefits? If you answer yes, you must attach documentation of your eligibility for these benefits which includes your name, address, and Social Security Number, and which shows that you are eligible to receive the benefits for the period of time for which you are requesting a deferment . Yes – Skip to Item 9 No – Continue to Item 3 . **3.** Are you diligently seeking full -time employment in the United States? Yes – Continue to Item 4 . No – You are not eligible for this deferment . **4.** Have you rejected offers of full -time employment in the United States in any field or at any salary or responsibility level? Yes – You are not eligible for this deferment. No – Continue to Item 5 . **5.** Is this an extension of a previously granted Unemployment Deferment? Yes – Continue to Item 6 . No – Skip to Item 7 . **6.** Have you made at least six diligent attempts to find full -time employment in the most recent 6 months? Yes – Continue to Item 7 . No – You are not eligible for this deferment . **7.** Is there a public or private employment agency within 50 miles of your current address? School placement offices, temporary employment agencies, and Web sites that allow users to search for or apply for employment do not qualify. Yes – Continue to Item 8 . No – Skip to Item 9 . **8.** Have you registered with the public or private employment agency? Yes – Continue to Item 9 . No – You are not eligible for this deferment . **9.** When did you become unemployed?

___ ___ - ___ ___ - ___ ___ ___ ___ **10.** Do you want your deferment to begin later than the date on which you became unemployed? Yes – Continue to Item 11 . No – Skip to Section 3 . **11.** When do you want your deferment to begin?

___ ___ - ___ ___ - ___ ___ ___ ___ Continue to Section 3 .Page 2 of 4 

### Borrower Name: ______________________________ Borrower SSN:

**___ ___**  **___ -**  **___ ___**  **- ___**  **___ ___**  **___ SECTION**  **3 :**  **BORROWER REQUEST,**  **UNDERSTANDINGS CERTIFICATIONS, AND AUTHORIZATION I request that**  my loan holder deferment repayment on my loans while I am unemployed . **I understand that: 1.**  I am not required to make payments of loa n principal o r interest during my deferment. **2.** My deferment will begin on the date I specified in Items 9 or 11 in Section 2 unless I selected “no” to Item 5 in Section 2, in which case my deferment will begin no earlier than 6 months prior to my loan holder’s receipt of this deferment request . **3.** My deferment will end on the earlier o f the date I obtain full -time employment or the date on which I exhaust my maximum cumulative eligibility . **4.** My deferment will only be granted in 6 - month increments and I must reapply for the deferment if I want to extend my deferment . **5.** Maximum cumulative eligibility **6.** 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 . **7.** 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 not ify my loan holder immediate ly when my qualification for the deferment e nds. **4.** I have read, understand, and meet the eligibility require ments 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**

**___ ___**  **- ___**  **___ -**  **___ ___**  **___ ___**  **SECTION 4**  **: WHERE TO SEND THE COMPLETED FORM** Return the completed form to : If you need help completing this form, call:

**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.Page 3 of 4 **SECTION 6 :**  **DEFINITIONS 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, 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 Loan. **Note:** Interest does not accrue on a Federal Consolidation Loan d uring 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 **on ly**  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. **Full -** **time employment** is defined as working at least 30 hours per week in a position expected to last at least 3 consecutive months. 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 **United States**, for the purpose of this deferment, includes any state of the Union, the District of Columbia, the Commonwealth of Puerto Rico, American Samoa, Guam, the Virgin Islands, the Commonwealth of the Northern Mariana Islands, the Freely Associated States (the Republic of the Marshall Is lands, the Federated States of Micronesia, and the Republic of Palau), and U.S. military bases and embassy compounds in foreign countries. 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 In terest 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 4 **SECTION 7**  **: 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 ide ntity, 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 instit utions, 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 .**  Accordi ng 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, plea se contact your loan holder directly ( see Section 4) .