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**EDU** 

## EDUCATION RELATED 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 covers four different deferments . Carefully review the information for each deferment type to determine whether you qualify for that deferment . **1.** Interest will not accrue on your subsidized loan(s) during deferment. However, interest will accrue on your unsubsidized loan(s). You may pay the interest that accrues on your unsubsidized loan(s) during deferment. If you do not pay this interest, 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. GRADUATE FELLOWSHIP DEFERMENT**  **2.** Do you hold a bachelor’s degree from an institution of higher education? Yes – Continue to Item 3 . No – You are not eligible this deferment . **3.** H ave you been accepted or recommended by an institution of higher education for acceptance into a graduate fellowship program on a full -time basis ? Yes – Continue to Item 4 . No – You are not eligible this deferment . **4.** Does your graduate fellowship program provide sufficient financial support to allow for full -time study for a period of at least 6 months? Yes – Continue to Item 5 . No – You are not eligible this deferment . **5.** Does your graduate fellowship program require, before the awarding of financial support, a written statement from you that explains your objectives? Yes – Continue to Item 6 . No – You are not eligible this deferment . **6.** Does your graduate fellowship program require you to submit periodic reports, projects, or other evidence of your progress? Yes – Continue to Item 7 . No – You are not eligible this deferment . **7.** Are you studying at a foreign university? Yes – Continue to Item 8 . No – Have an authorized official complete Section 3 and then continue to Section 4 . **8.** Will your graduate fellowsh ip program accept the course of study from the foreign university for completion of the fellowship program? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – You are not eligible this deferment .Page 2 of 7 

### Borrower Name: ______________________________ Borrower SSN:

**___ ___**  **___ -**  **___ ___**  **- ___**  **___ ___**  **___ SECTION 2:**  **DEFERMENT REQUEST (CONTINUED) PART B. REHABILITATION TRAINING**  **DEFERMENT 9.**  Is your training program licensed, approved, certified, or recognized as providing rehabilitation training to disabled individuals by the Department of Veterans Affairs or a state agency responsible for the treatment of drug abuse, mental health, or alcoho l abuse? Yes – Continue to Item 0 . No – You are not eligible this deferment . **10.** Does your training program provide services under a written, individualized plan that specifies the date the services are expected to end? Yes – Continue to Item 11 . No – You are not eligible this deferment . **11.** Does your program require a substantial commitment by you to your reha bilitation? Substantial commitment means a commitment of time and effort that would normally prevent a person from being employed 30 or more hours per week. Yes – Continue to Item 12 . No – You are not eligible this deferment. **12.** Are you receiving or scheduled to receive drug abuse, treatment, mental health services, or alcohol abuse treatment rehabilitation services? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – You are not eligible this deferment . **PART C. INTERNSHIP/RESIDENCY DEFERMENT. Maximum eligibility for this deferment is 24 months.**  Before you complete Part C, read the additional eligibility information in Section 8 . **13.** Have you been accepted to an internship/residency program? Yes – Continue to Item 14 . No – You are not eligible this deferment . **14.** Did your program require, as a condition of admission, that you have a bachelor’s degree from an institution of higher education? Yes – Continue to Item 15 . No – You are not eligible this deferment . **15.** Is your interns hip/residency program a program in which you will receive training under supervision? Yes – Continue to Item 16 . No – You are not eligible this deferment . **16.** Will completion of this program lead to a degree or certificate awarded by an institution of higher education, a hospital, or a health care facility that offers postgraduate training? Yes – Have an authorized official complete Section 3 and then co ntinue to Section 4 . No – Continue to Item 17 . **17.** Will completion of the program be required by you can begin professional pract ice or service? Yes – Have an authorized official complete Section 3 and then continue to Section 4 . You must also attach a separate statement form the appropriate state licensing agency certifying this requirement. No – You are not eligible this deferment . **PART D. TEACHER SHORAGE AREA DEFERMENT Maximum eligibility for this deferment is 36 months.**  Before you complete Part D, read the additional eligibility information in Section 8 . **18.** Do you teach full time in a public or not-for- profit private elementary or secondary school? Yes – Continue to Item 19 . No – You are not eligible this deferment . **19.** Do you teach in a geographic region or specific grade level, academic, instructional, subject matter, or discipline classification that has been designated as a shortage area by the U.S. Department of Education? If you are unsure, contact your Chief School Administrative or Chief State School Officer for confirmation. Yes – Have an authorized official complete Section 3 and then continue to Section 4 . No – You are not eligible this deferment . If you previously received this deferment, but your area is no longer designated as a shortage area, check “yes”.Page 3 of 7 **Borrower Name: ______________________________ Borrower SSN:**

**___ ___**  **___ -**  **___ ___**  **- ___**  **___ ___**  **___ 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**. **20.** Did the borrower select “yes” in Items 8, 11, 17, or 19 ?Yes – Complete Items 21 through 22 . No – Do not complete this section . **21.** The program/service begins/began on :

___ ___ - ___ ___ - ___ ___ ___ ___ **22.** The program/service is expected to end/ended on :

___ ___ - ___ ___ - ___ ___ ___ ___ **23.** Did the borrower select “yes” in Item 19 ? Yes – Complete Items 23 through 28 . No – Skip to Item 29 . **24.** Shortage area (geographic area/curriculum) in which the borrower is/was teaching:

____________________________________________ **25.** The shortage area was designated by the U.S. Department of Education for the state of: __________ **26.** The borrower is/was teaching in the shortage area for the school year that began on:

___ ___ - ___ ___ - ___ ___ ___ ___ **27.** The borrower is/was teaching in the shortage area for the school year that ends on:

___ ___ - ___ ___ - ___ ___ ___ ___ **28.** During the time periods described by Items 26 and 27, the borrower is/was teaching grade level:

____________________________________________ **29.** Did the borrower select “yes” to Item 17 ? Yes – Complete Item 30 . Read the certification below and complete Items 31 through 38 . No – Read the certification below and complete Items 31 through 38 . **30.** Provide the name of the borrower’s internship/residency program:

____________

_______________________________ **I certify, to the best of my knowledge and belief, that :**   The borrower named above is/was in the program/teaching service indicated in Section 2;  That the borrower and the service meet all conditions indicated by the borrower’s responses in Section 2; and  The information that I have provided in Section 3 is accurate. **31.** Name of Institution:

______ ______________________ __________________________________________________ **32.** Address:_____________________________

___________________________________________________ ________ **33.** Name/Title:_______________

___________________________________________________ ___________________ **34.** Signature:___________

__________________________________________________ _________________________ **35.** OPEID (if applicable):

_____________ ____________________________________________________ _____________ **36.** City, State, Zip Code:

_________ _________________________________ _____ , __

________ __ ____ __________

___ **37.** Telephone: (

________ )

________ - ________ _ _____ **38.** Date:

___ ___ - ___ ___ - ___ ___ ___ ___Page 4 of 7 

### Borrower Name: ______________________________ Borrower SSN:

**___ ___**  **___ -**  **___ ___**  **- ___**  **___ ___**  **___ SECTION**  **4 :**  **BORROWER REQUEST,**  **UNDERSTANDINGS CERTIFICATIONS, AND AUTHORIZATION I request**  to defer repayment of my loans for the period during which I meet th e eligibility criteria outlined in Section 2. **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 the program or teaching 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 in the program or teaching service, or the ending date as certified by the authorized official. **4.** 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. **5.** 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 ends. **4.** I have read, understand, and meet the eligibility requires of th e 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 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. An authorized official must either complete Section 4 or attach the organization’s own signed certification listing the required information. Include your name an account number on any docu mentation 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 t o each loan holder. **SECTION 6**  **: WHERE TO SEND THE COMPLETED FORM** Return the completed form to : If you need help completing this form, call:Page 5 of 7 **SECTION 7**  **: DEFINITIONS**  An **authorized official**  who may complete Section 3 is either: **(1)** an official of the Graduate Fellowship Program, Rehabilitation Training Program, or Internship/Residency Program; or **(2)** the Chief School Administrator (if you are teaching in teacher shortage areas, additional certification may be required if the Chief State School Officer has not provided a list of approved shortage areas to school administrators). **Capitalization** is the addition of unpaid interest to the principal balance of your loan. As a result of cap italization, 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 followi ng 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 Federa l 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 Fede ral 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 applicatio n 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) P** **rogram** 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 extens ion 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, o r 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.Page 6 of 7 **SECTION 8**  **: ELIGIBILITY**  **REQUIREMENTS** For the **graduate fellowship deferment** (Section 2, Part A), you are only eligible for the deferment if you answer “yes” in Items 2 – 6, and, as applicable, “yes” in Item 8 . For the **rehabilitation training deferment** (Section 2, Part B), you are only eligible for the deferment if you answer “yes” in Items 9 – 12 . For the **internship/residency deferment** (Section 2, Part C), you are only eligible for the deferment if, in addition to meeting the criteria below, you answer “yes” in Items 13 – 15 and you answer “yes” in Item 16 or 17 . For the **teacher shortage area deferment** (Section 2, Part D), you are only eligible for the deferment if, in addition to meeting the criteria below, you answer “yes” in Items 18 and 19 . For the **internship/residency deferment** and the **teacher shortage area deferment** only, 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 Ju ly 1, 1993 when you received a FFEL Program loan on or after July 1, 1993 . For the **internship/residency deferment** only, in addition to meeting the criteria above, Federal PLUS Loans are only eligible for this deferment if the loan was disbursed before August 15, 1983. Federal Consolidation Loans are not eligible for this deferment. **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 col lecting 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 guaranty agencies in order to ve rify 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 stud ent 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 violationPage 7 of 7 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 No tice** **.** 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, pl ease contact your loan holder directly (see Section 6 ) .