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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

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: 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 annual 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: UNDERSTANDINGS, PROMISE TO PAY, AUTHORIZATION, AND REQUEST

 I understand that: 

1. I will have reaffirmed the excess loan 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, my 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 under 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 loan 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 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.

 I request that my loan holder send documentation of my reaffirmation to the school listed below:

School Name: _________________________________________________________________________________

Borrower Signature _______________________________________________ Date ___ ___ - ___ ___ - ___ ___ ___ __
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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 (both 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.

 Federal 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 Program, 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

Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C. 552a)

requires that the following notice be provided to 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 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 Direct Loan

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) 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 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
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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

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. 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 (0.08 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).