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 RPS

REPAYMENT PLAN REQUEST:

Standard Repayment Plan/Extended Repayment Plan/Graduated Repayment Plan

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

OMB No. 1845-0014

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: REPAYMENT PLAN REQUEST

1. Choose one of the following:

I want to select a plan for all of my Direct Loans.

I want to select a plan for only my Direct Loans that are not eligible for the Income-Based Repayment (IBR), Pay As 

You Earn, or Income-Contingent Repayment (ICR) Plan. The following loans are not eligible for these plans:

 Direct Parent PLUS Loans: not eligible for IBR, Pay As You Earn, or ICR.

 Direct Consolidation Loans made on or after July 1, 2006 that repaid Direct Parent PLUS Loans or Federal Parent 

PLUS Loans: not eligible for IBR or Pay As You Earn. These loans are eligible for ICR. 

 Direct Consolidation Loans made before July 1, 2006 that repaid Direct Parent PLUS Loans or Federal Parent 

PLUS Loans (these are called “Direct PLUS Consolidation Loans”): not eligible for IBR, Pay As You Earn, or ICR. 

2. Check the box for the repayment plan that you wish to select:

These plans are described in Section 5. Sample payment amounts for each plan are provided in Section 7.

Standard Graduated Extended – Fixed Payments Extended – Graduated Payments

Note: If you are interested in the IBR, Pay As You Earn, or ICR plan, visit StudentLoans.gov to read or complete the 

application or StudentAid.gov to learn more. To help you compare these plans to the Standard, Graduated, and 

Extended plans, sample payments amounts for the IBR, Pay As You Earn, and ICR plans are provided in Section 7.

SECTION 3: BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION

 I understand that: (1) I must choose the same repayment plan for all of my Direct Loans unless I want to repay my 

loans under the IBR, Pay As You Earn, or ICR Plan and I have some loans that may not be repaid under those plans. In 

this case, I may select the IBR, Pay As You Earn, or ICR plan for the loans that are eligible for repayment under those 

plans, and may select a different repayment plan for the loans that may not be repaid under IBR, Pay As You Earn, or 

ICR. (2) If I am beginning repayment of my loans for the first time and I do not select a repayment plan, I will be placed 

on the Standard Repayment Plan. (3) If I am delinquent in making payments under my current repayment plan at the 

time I request to change to a different plan, my servicer may grant me a forbearance to cover any payments that are 

overdue at the time I enter the repayment plan I selected in Section 2. Unpaid interest that accrues during this 

forbearance period may be capitalized at the end of the forbearance period.

 I certify that (1) The information I have provided on this form is true and correct and (2) I have read and understand 

the terms of the repayment plan that I requested in Section 2, as explained in Sections 5 and 7.

 I authorize the U.S. Department of Education (and its agents or 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 Signature _______________________________________________ Date ___ ___ - ___ ___ - ___ ___ ___ ___
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SECTION 4: INSTRUCTIONS FOR COMPLETING THE FORM

Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Use only numbers. Example: January 31, 

2013 = 01-31-2013. If you need help completing this form, contact your federal loan servicer. If you want to apply for a 

repayment plan and your Direct Loans are serviced by different federal loan servicers, you must submit a separate 

repayment plan request to each loan servicer.

Return the completed form and any required documentation to the address shown in Section 6.

SECTION 5: REPAYMENT PLAN DESCRIPTIONS

STANDARD REPAYMENT PLAN

Under this plan, you will pay a fixed amount each 

month over the course of your maximum repayment 

period in an amount that will ensure that your loan is 

fully repaid by the end of your repayment period. This 

plan may result in lower total interest paid when 

compared to other plans. For Direct Subsidized Loans, 

Direct Unsubsidized Loans, and Direct PLUS Loans, the 

maximum repayment period is 10 years. For Direct 

Consolidation Loans, the maximum repayment period 

ranges from 10 to 30 years, depending on loan debt.

GRADUATED REPAYMENT PLAN

Under this plan, your payments start out low and then 

increase every two years. No single payment under this 

plan will be more than three times greater than any 

other payment. Your payment amount will ensure that 

your loan is fully repaid by the end of your repayment 

period. Generally, the amount you will repay over the 

life of your loan will be higher under this plan than 

under the Standard Repayment Plan. This plan may be 

beneficial if your income is low now but is likely to 

steadily increase. For Direct Subsidized Loans, Direct 

Unsubsidized Loans, and Direct PLUS Loans, the 

maximum repayment period is 10 years. For Direct 

Consolidation Loans, the maximum repayment period 

ranges from 10 to 30 years, depending on loan debt.

EXTENDED REPAYMENT PLAN

 You may choose this plan only if (1) you had no 

outstanding balance on a Direct Loan on 

October 7, 1998 or on the date you obtained a 

Direct Loan after that date, and (2) you owe 

more than $30,000 in outstanding Direct Loans.

 Under this plan, you have the option of making 

either fixed or graduated payments over your 

maximum repayment period. Your payment 

amount will ensure that your loan is fully repaid 

by the end of your repayment period. If you 

choose graduated payments, your payments 

start out low and then increase every two years. 

 Under either the fixed or graduated monthly 

payment option, the Extended Repayment Plan 

will give you a lower monthly payment on your 

non-consolidation loans than the Standard or 

Graduated Repayment Plans. However, 

because of the longer repayment period, you 

will pay more interest over the life of your 

loans. 

 For all loan types, the maximum repayment 

period is 25 years.

See Section 7 for sample repayment amounts under each of these repayment plans.

SECTION 6: WHERE TO SEND THE COMPLETED REPAYMENT PLAN REQUEST

Return the completed form and any required 

documentation to:

(If no address is shown, return to your loan servicer.)

If you need help completing this form, call:

(If no telephone number is shown, call your loan 

servicer.)
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SECTION 7: SAMPLE PAYMENT AMOUNTS

Below are two tables that provide examples of monthly payment amounts under the Standard, Graduated, and Extended repayment plans. The figures provided 

in these tables are estimates. Various factors, including your actual interest rate and the amount of your loan debt, may cause your payment amount to differ 

from the monthly payment amounts shown in these tables. Your federal loan servicer will provide you with the actual monthly payment amount after you select 

a repayment plan.

Direct Subsidized Loans, Direct Unsubsidized Loans, and Direct PLUS Loans

Debt

Standard (10 years) Graduated (10 years) Extended-Fixed (25 years) Extended-Graduated (25 years)

Payment Total Paid Minimum 

Payment

Maximum 

Payment Total Paid Payment Total Paid Minimum Payment

Maximum 

Payment Total Paid

$20,000 $245 $29,437 $144 $431 $32,177 Not Eligible - Not Eligible - -

$30,000 $368 $44,155 $216 $647 $48,265 Not Eligible - Not Eligible - -

$40,000 $491 $58,873 $287 $862 $64,353 $315 $94,614 $275 $417 $101,515 

$50,000 $613 $73,592 $359 $1,078 $80,442 $394 $118,268 $344 $521 $126,899 

$60,000 $736 $88,310 $431 $1,294 $96,530 $473 $141,921 $413 $625 $152,280 

$70,000 $859 $103,028 $503 $1,509 $112,618 $552 $165,575 $481 $730 $177,664 

$80,000 $981 $117,747 $575 $1,725 $128,706 $631 $189,228 $550 $834 $203,046 

$90,000 $1,104 $132,465 $647 $1,940 $144,795 $710 $212,882 $619 $938 $228,427 

All payments are calculated using a fixed interest rate of 8.25%, which is the maximum interest rate on Direct Subsidized and Unsubsidized Loans for undergraduate students.

Direct Consolidation Loans

Debt

Standard (10-30 years) Graduated (10-30 years) Extended-Fixed (25 yrs.) Extended-Graduated (25 years)

Maximum 

Repayment 

Period

Payment Total Paid

Maximum 

Repayment 

Period

Minimum 

Payment

Maximum 

Payment Total Paid Payment Total Paid Minimum Payment

Maximum 

Payment Total Paid

$20,000 20 years $170 $40,899 20 years $138 $241 $44,420 Not Eligible - Not Eligible - -

$30,000 20 years $256 $61,349 20 years $206 $362 $66,631 Not Eligible - Not Eligible - -

$40,000 25 years $315 $94,614 25 years $275 $417 $101,515 $315 $94,614 $275 $417 $101,515 

$50,000 25 years $394 $118,268 25 years $344 $521 $126,899 $394 $118,268 $344 $521 $126,899 

$60,000 30 years $451 $162,274 30 years $413 $549 $166,145 $473 $141,921 $413 $625 $152,280 

$70,000 30 years $526 $189,319 30 years $481 $640 $193,841 $552 $165,575 $481 $730 $177,664 

$80,000 30 years $601 $216,365 30 years $550 $732 $221,531 $631 $189,228 $550 $834 $203,046 

$90,000 30 years $676 $243,410 30 years $619 $823 $249,228 $710 $212,882 $619 $938 $228,427 

All payments are calculated using a fixed interest rate of 8.25%.
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SECTION 7: SAMPLE PAYMENT AMOUNTS (CONTINUED)

Below are three tables that provide examples of monthly payment amounts under the IBR, Pay As You Earn, and ICR plans. The figures provided in these tables are 

estimates, and use an interest rate of 8.25%. Various factors, including your actual interest rate, the amount of your loan debt, your income, and whether and how 

quickly it rises (these figures assume a rate of increase of 5% per year), may cause your payment amount to differ from the monthly payment amounts shown in these 

tables.

Income-Based Repayment (IBR) Plan

Debt

Starting income of $25,000 Starting income of $40,000 Starting income of $60,000

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

$20,000 $97 $245 $45,835 240 Not Eligible - - - Not Eligible - - -

$40,000 $97 $491 $80,171 300 $285 $491 $74,134 179 Not Eligible - - -

$60,000 $97 $538 $80,919 300 $285 $736 $155,029 283 $535 $736 $97,632 145

$80,000 $97 $538 $80,919 300 $285 $981 $184,670 300 $535 $981 $158,503 198

$100,000 $97 $538 $80,919 300 $285 $1,143 $188,307 300 $535 $1,227 $241,490 259

Pay As You Earn Plan

Debt

Starting income of $25,000 Starting income of $40,000 Starting income of $60,000

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay 

(Mos.)

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

$20,000 $65 $245 $34,735 240 $190 $245 $31,449 136 Not Eligible - - -

$40,000 $65 $260 $34,914 240 $190 $491 $82,552 240 $356 $491 $65,087 145

$60,000 $65 $260 $34,914 240 $190 $576 $84,514 240 $356 $736 $131,919 229

$80,000 $65 $260 $34,914 240 $190 $576 $84,514 240 $356 $981 $150,454 240

$100,000 $65 $260 $34,914 240 $190 $576 $84,514 240 $356 $997 $150,647 240

Income-Contingent Repayment (ICR) Plan

Debt

Starting income of $25,000 Starting income of $40,000 Starting income of $60,000

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

Initial 

Payment

Final 

Payment

Total 

Paid

Time to 

Repay (Mos.)

$20,000 $151 $189 $43,755 253 $193 $217 $33,978 168 $219 $244 $30,930 134

$40,000 $225 $420 $99,772 286 $385 $434 $67,957 168 $438 $489 $61,860 134

$60,000 $225 $676 $140,178 300 $475 $666 $108,859 184 $658 $733 $92,790 134

$80,000 $225 $926 $151,474 300 $475 $956 $179,997 238 $809 $978 $125,235 137

$100,000 $225 $926 $151,474 300 $475 $1,372 $280,318 300 $809 $1,243 $173,158 162
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SECTION 8: IMPORTANT NOTICES

Privacy Act Notice. The Privacy Act of 1974 (5 USC 552a) 

requires that the following notice be provided to you:

The authority for collecting the requested information 

from and about you is §421 et seq., §451 et seq., and/or 

§461 et seq. of the Higher Education Act (HEA) of 1965, as 

amended (20 USC 1071 et seq., 20 USC 1087a et seq., 

and/or 20 USC 1087aa et seq.), and the authorities for 

collecting and using your Social Security Number (SSN) are 

§484(a)(4) of the HEA (20 USC 1091(a)(4)) and 31 USC 

7701(b). Participating in the Federal Family Education 

Loan (FFEL) Program, William D. Ford Federal Direct Loan 

(Direct Loan) Program, and Federal Perkins Loan (Perkins) 

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 Program, Direct Loan 

Program, and/or Perkins Program, 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) 

become delinquent or in default. 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 status, 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 USC 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 it displays 

a currently valid OMB control number. Public reporting 

burden for this collection of information is estimated to 

average 0.5 hours (30 minutes) per response, including 

the time for reviewing instructions, searching existing data 

resources, gathering and maintaining the data needed, 

and completing and reviewing the information collection. 

Individuals are obligated to respond to this collection to 

obtain a benefit in accordance with 34 CFR 685.208. Send 

comments regarding the burden estimate(s) or any other 

aspect of this collection of information, including 

suggestions for reducing this burden to the U.S. 

Department of Education, 400 Maryland Avenue, SW, 

Washington, DC 20210-4537 or e-mail 

ICDocketMgr@ed.gov and reference OMB Control 

Number 1845-0014. Note: Please do not return the 

completed form to this address.

If you have questions regarding the status of your 

individual submission of this form, contact your loan 

servicer (see Section 6).