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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**  **ELIGIBILITY** 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 (“overborrowing”) , as shown below

. To get complete information about your loan(s) or contact information regarding your loan holder(s), you may visit the National Student Loan Database System (NSLDS) at www.NSLDS.ed.gov To regain eligibility for federal student financial aid, you may either : **1.** R epay the excess loan amount now, in which case you should contact your loan holder for instructions and not complete this form; or **2.** Agree to repay the excess according to the terms and conditions of your promissory note (“reaffirmation”), in which case you should review the information in Section 3 and then sign and return this form to your loan holder

. **NOTE:** If the overborrowing was caused by more than one loan and the loans are held by different loan holders, a separate form will need to be submitted to each loan holder. 

### SECTION **3 :**  **SCHOOL AND LOAN INFORMATION (TO BE COMPLETED BY THE SCHOOL)**  **NOTE:** If NSLDS shows that a student c onsolidated the loan(s) that caused in the inadvertent overborrowing into a Direct or FFEL Consolidation Loan, no further action on the part of the borrower is needed. By signing the consolidation loan promissory note, the borrower agreed to repay any exce ss loan amount. Name of Institution: ______________________________________________ OPE

- ID (if applicable)__________________ Address: ________________________________________ City, State, Zip Code: ________________________________ Name/Title of School Official: _____________________________________ Telephone: _________________________ Loan Type First Disb.

Date Disbursed

Amount Excess

Amount Loan Holder/ServicerPage 2 of 3 

### Borrower Name: ______________________________ Borrower SSN:

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

 **I request** that my loan holder send confirmation of my reaffirmation to the school identified in Section 3.

 **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. **Borrower Signature**

_______________________________________________ **Date**

___ ___ - ___ ___ - ___ ___ ___ __ 

### SECTION **4 : WHERE TO SEND THE COMPLETED**  **REAFFIRMATION AGREEMENT** Return the completed form to: (if no address is shown, return to your loan holder) If you need help completing this form, call: (if no telephone number is shown, call your loan holder)



### 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 Cons olidation) 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. 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 A ssistance 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 overborrowing**  is the exceeding of an annual or aggregate loan limit without any evidence that you exceeded the limit as a result of deliberate action on your part or on the part of the school that determined your eligibility for the loan.Page 3 of 3 

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

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. 5 5 2 a ) re qu i re s th a t t h e fo ll o w i n g n ot 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 Wil liam 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. 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 ve r i fy you r i d en t i ty, t o det e r m i n e you r e li g i b ili ty t o re c e i ve 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 co 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 co rd s not 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 ot 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 va t e pa rt i e s s u c h a s re l a t i ve 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 ve r i f y you r i d e n t i ty, t o det e r mi n e you r e li g i b ili ty t o re c e i ve 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 ve st i g a t e po ss i b le frau d a n d t o ve 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 e 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 t o 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 t o 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 t o 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, 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 t o 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 t o 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 t o m e m be rs o f Co n g re s s if yo u a s k t h e m t o 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 o y m en t co mp l a i n ts, g r i e va 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 e va n t re c o rd s t o 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 ro v 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).