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**REA** 

## REAFFIRMATION AGREEMENT **William D. Ford Federal Direct Loan (Direct Loan) Program Federal Family Education Loan (FFEL) Program**  OMB No. 1845

-XXXX D RAFT 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, imprisonme nt, 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 **: INFORMATION ABOUT REAFFIRMATION AND LOAN**  **TO BE REAFFIRMED** You have lost eligibility for federal student financial aid because you inadvertently received a Direct Loan or FFEL program loan that caused you to exceed the ann ual or aggregate loan limit, as shown below . To regain eligibility for federal student financial aid, you may either **(1)** repay the excess loan amount now or **(2)** agree to repay the excess according to the terms and conditions of your promissory note. Repaying the excess according to the terms and conditions of your promissory note is called reaffirmation. If you want to repay the excess amount, contact your loan holder for instructions. If you want to reaffirm the excess amount, review the information below, enter the name of the school where you are seeking additional federal student aid in Section 3, then sign and return this form to your loan holder

. Loan Type First

Disb. Date Interest

Rate Loan

Amount Excess

Amount School



### SECTION **3 :**  **UNDERSTANDING S** **, PROMISE TO PAY** **, AUTHORIZATION , AND REQUEST** 

 **I understand that:**  **1.** I will have reaffirmed the excess l oan amount that I received only after I sign and return this form to my loan holder and it is processed

. **2.** After I have reaffirmed the excess loan amount, m y school will determine what types and amounts of federal student financial aid I am eligible to receive. **3.** Reaffirmation does not make me eligible to receive additional Direct Subsidized Loans or Direct Unsubsidized Loans if I have no remaining eligibility u nder the applicable total (aggregate) limit

.  **I promise** to pay to the loan holder the excess loan amount shown in Section 2 under the terms of the promissory note that I signed to receive the Direct Loan or FFEL program l oan identified in Section 2 , plus interest and other charges and fees that may become due as provided in my promissory note

.  **I authorize** my loan holder and its agents or contractors to contact me regarding my reaffirmation agreement o r 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.

 **I request** that my loan holder send documentation of my reaffirmation to the school listed below : **School Name** : _________________________________________________________________________________ **Borrower Signature**

_______________________________________________ **Date**

___ ___ - ___ ___ - ___ ___ ___ __Page 2 of 3 

### SECTION **4 : WHERE TO SEND THE COMPLETED**  **REAFFIRMATION AGREEMENT** Return the completed form to: If you need help completing this form, call:



### SECTION 5 **: DEFINITIONS** 

 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.

 The **Federal Family Education Loan (FFEL) Program** includes Federal Stafford Loans (bot h subsidized and unsubsidized) , Federal PLUS Loans, Federal Consolidation Loans , and Federal Supplemental Loans for Students (SLS)

.  The **holder** of your Direct Loan Program loan(s) is the Department. The holder of your FFEL Program loan(s) may be a lender, a guaranty agency, or the Department. This form will only be used for FFEL Program loans held by the Department. Your loan holder may use a servicer to handle billing and other communications related to your loans. References to “your loan holder” on this form mean either your loan holder or your servicer.

 **F ederal**  **student financial aid**  includes the Federal Pell Grant Program, the Federal Supplemental Educational Opportunity Grant (FSEOG) Program, the Teacher Education Assistance for College and Higher Education (TEACH) Grant Program, the Federal Work

- Study Pr ogram, the William D. Ford Federal Direct Loan (Direct Loan) Program , and the Federal Perkins Loan Program

.  **Inadvertent** means the absence of any evidence that you exceeded the annual or aggregate loan limit as a result of deliberate action on your part or on the part of the school that determined your eligibility for the loan. 

### SECTION **6 :**  **IMPORTANT NOTICES P**  **ri v** **a c** **y Ac** **t No** **tic e**  **.** T h e P r i v a cy Act o f 1 9 74 ( 5 U

. S

. C

. 5 5 2 a ) re qu i re s th a t t h e fo ll o w i n g n o t i c e b e p rov i de d t o you: The authority for collecting the requested information from and about you is §451 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1087a et seq. ) and the authorities for collecting and using your Social Security Number (SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and 31 U.S.C. 7701(b). Participating in 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 yo ur SSN, to participate. T h e p r i n c i pa l p u rp o s e s fo r c o ll e ct i n g t h e i n fo r m a t i o n o n t h is fo r m , i n c l u d i n g you r SS N , a re t o v e r i fy you r i d en t i ty, t o de t e r m i n e you r e li g i b ili ty t o re c e i v e a l o a n o r a be ne fi t o n a l oa n (s u c h a s a d e fe r m e n t, fo r b e a ra n c e , d i sch a rg e , o r fo rg i ve ne ss ) u n d e r t h e D i re ct Loa n P ro g ra m , t o pe r m it t h e s e rv i c i n g o f you r l o an (s) , a n d , if it be c o m e s n e c e ss a ry, t o l o c a t e yo u a n d t o co ll e ct a n d re po rt o n yo u r l o a n (s ) if you r l oan (s ) b e c o m e s d e l i n q u en t o r de fau l ts

. We a l s o u s e yo u r S S N a s a n a cco un t i d e n t i fi e r a n d t o pe r mit yo u t o a cc e s s your a cc o u n t i n fo r m a t i o n e l e ctron i c a ll y . T h e i n fo r ma t i o n in yo u r file m a y b e d i sc l o s ed , o n a c a se by- c a s e b a s is o r u nd e r a co m p u t e r m a tc h i n g p rog ra m, t o t h i rd pa rt i e s a s au t ho r i ze d u n d e r rou t i n e u s e s in th e ap p ro p r i a t e syst em s o f re c o rd s no t i c e s
. T h e ro u t i n e us e s o f t h is i n fo r ma t i o n i n c l ud e , bu t a re n o t li m i t e d t o, i t s d i sc l o s u re t o fe de ra l, st a t e , o r l o c a l a ge n c i e s, t o p r i v a t e pa rt i e s s u c h a s re l a t i v e s, p re se n t a n d fo r me r e mp l o ye rs, bu s i ne s s a n d pe rso na l a ss o c i a t e s, t o c on s u m e r re port i n g a g e n c i e s, t o fi n a n c i a l a n d e d u c a t i ona l i n st i t u t i on s, a n d t o g ua ran ty a g e n c i e s in o rd e r t o v e r i f y you r i d e n t i ty, t o de t e r mi n e you r e li g i b ili ty t o re c e i v e a l o a n o r a b e n e fit o n a l o a n , t o pe r m it th e s e rv i c i n g o r c o ll e ct i o n o f yo u r l o an (s) , t o en fo rc e th e t e r m s o f th e l o an (s) , t o i n v e st i g a t e po ss i b le frau d a n d t o v e r i f y c o m p li an ce w i t h fe d e ra l st u de n t fi n a n c i a l a id p ro g ra m re gu l a t i on s, o r t o l o c a t e yo u if yo u b e co m e de li nq u e n t in yo u r l o a n p a y m e n t s o r if yo u de fa u l t

. To p rov i d e d e fa u lt ra t e c a l c u l a t i on s, d i sc l o s u re s m a y b e m a d e t o gu a ra n ty a g en c i e s, t o fi nan c i a l a n d ed u c a t i o na l i n st i t u t i o n s, o r t o st a t e a g en c i e s
. To p ro v i d e fi n an c i a l a id h i st o ry i n fo r m a t i o n , d i sc l o s u re s m a y b e m a d ePage 3 of 3 t o e d u c a t i o na l i n st i t u t i on s
. To a ss i st p rog ra m a d mi n i stra t o rs w i t h tra ck i n g re fun d s a n d c an c e l l a t i o n s, d i sc l o s u re s ma y b e m a d e to g u a ra n ty a g en c i e s, t o fi n an c i a l a n d e du ca t i o na l i n st i t u t i on s, o r t o fe de ra l o r st a t e ag en c i e s
. To p rov i d e a stan da rd i ze d m etho d fo r e du ca t i o n a l i n st i t u t i o n s t o e ffi c i en t ly s ub mit stu d e n t e n ro ll m ent st a t u s e s, d i sc l o s u re s ma y b e m a d e to g uaran ty a ge n c i e s o r t o fi n a n c i a l an d e du c a t i o n a l i n st i t u t i on s
. To c o u n s e l yo u in re pa ym e n t e ffo rts, d i sc l o s u re s m a y b e m a d e to g u a ra n ty a g en c i e s, to fi n an c i a l a n d e du ca t i o na l i n st i t u t i on s, o r t o fe de ra l, st a t e , o r l o c a l ag en c i e s
. I n t h e even t o f li t i ga t i o n , we ma y s e n d re co rd s to th e D e p a rt m e n t o f J u st i c e, a c ou rt, adj u d i c a t i ve bo d y, c oun se l, pa rty, o r w i tn e s s if t h e d i sc l o s u re is re l eva n t a n d n e c e ss a ry t o t he li t i ga t i on
. I f t h is i n fo r m a t i on , e i t he r a l o n e o r w i t h ot he r i n fo r m a t i on , i nd i c a t e s a p ote n t i a l v i o l a t i o n o f l a w, we m a y se n d it to th e a p p ro p r i a t e au t ho r i ty fo r a ct i on
. We ma y s end i n fo r m a t i o n to m e m be rs o f Co n g re s s if yo u a s k t h e m to h e lp yo u w i t h fe d e ra l st u de n t a id q u e st i on s
. I n c i rc um st an c e s i n vo l v i n g e m p l oy m en t co mp l a i n ts, g r i eva n c e s, o r d i sc i p li na ry a ct i on s, w e ma y d i sc l o s e re l eva n t re c o rd s to adj ud i c a t e o r i n ve st i g a t e th e i ss ue s
. I f p rov i d e d fo r by a co ll e ct i ve b a rg a i n i n g a g re e m e n t, w e ma y d i sc l o s e re co rd s t o a l ab o r o rg an i z a t i on re co g n i ze d u n d e r 5 U

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. D i sc l o s u re s ma y b e m a d e to o u r con tra ct o rs fo r t h e pu r po se o f p e rfo r m i n g an y p rog ra m m a t ic fun ct i o n t ha t req u i re s d i sc l o s u re o f re co rd s
. Be fo re m a k i n g an y s u c h d i s c l o s u re , we w i ll requ i re t h e co n tra ct o r t o m a i n t a in P r i va cy Act s a feg u a rd s
. D i sc l o s u re s m a y a l so b e m ad e t o q ua li fi e d re se a rc h e rs u n de r P r iva cy Act s a fe g ua rd s
. **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 valid OMB control number. The valid OMB control number for this collection is 1845

-XXXX . Public reporting burden for this collection of information is estimated to average 5 minutes (0. 0 8 hours) per response, including the time for reviewing instructions, searching existing data resources, 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 668.34(d). If you have questions regarding the status of your individual submission of this form, contact your loan holder (see Section 4).