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**HRD** 

## ECONOMIC HARDSHIP **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) ___ ___ ___ - ___ ___ - ___ ___ ___ ___

_____________________________ _______ _______

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________________________ , _______ __________ (

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_ _ ___ _________ (

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___________________________________________ **SECTION 2: DEFERMENT**  **ELIGIBILITY Rea**  **d Section 7 before completing Section 2.**  **1.** Have you been granted an Economic Hardship Deferment on another federal student loan for the same period of time for which you are applying for this deferment? A federal student loan includes a loan made under the Direct Loan Program, the FFEL Program, or the Perkins Loan Program. Yes – Attach documentation of the deferment. Skip to Section 3. No – Continue to Item 2 . **2.** Have you received payments under a Federal or State public assistance program that supports the period of time for which you are applying for this deferment ? Qualifying programs include: Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), Supplemental Nutritional Assistance Program (SNAP), State general public assistance, or other means-tested benefits . Yes – Attach documentation of the payments . Skip to Section 3. No – Continue to Item 3 . **3.** Are you serving as Peace Corps volunteer? Yes – Attach documentation certifying your period of service in the Peace Corps . Skip to Section 3. No – Continue to Item 4 . **4.** Do you work full time (see Section 5) ? Yes – Continue to Item 5 . No – You do not qualify for this deferment. Consider an income-driven repayment plan, unemployment deferment, or forbearance. **5.** What is your monthly income? $

__ _____________ You must attach documentation of your monthly income. Monthly income is either (you choose):  Your gross income from all sources; or  One-twelfth of the Adjusted Gross Income from your most recent federal income tax return. **6.** What is your family size (see Section 5) ?

___ ___ **7.** Is the amount you reported in Item 5 less than 150% of the poverty guideline for your family size and state of residence (see Table 1) ? Yes –Continue to Item 8 . No – You do not qualify for this deferment. Consider an income-driven repayment plan or forbearance. Table 1. 150% of the Poverty Guidelines for 201 5 (Monthly) **Family Size Alaska**  **Hawaii All Others**  **1** $1,840 . 00 $1,693.75 $1,471.25 **2** $2,490 . 00 $2,2 91 . 25 $1,991 .25 **3** $3, 125 . 00 $2,888 . 75 $2, 511.25 **Each add’l person, add**  $635.00 $597 . 5 0 $5 20.00Page 2 of 5 

### Borrower Name: ______________________________ Borrower SSN:

**___ ___**  **___ -**  **___ ___**  **- ___**  **___ ___**  **___ SECTION**  **2 :**  **DEFERMENT REQUEST (CONTINUED)**  **8.** When do you want your deferment to begin?



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___ ___ ___ ___ Continue to Item 9 . **9.** 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 to Section 3 . No – Continue to Section 3 . **SECTION 3**  **: BORROWER**  **REQUEST, UNDERSTANDINGS CERTIFICATIONS, AND AUTHORIZATION**  **I request to** defer repayment of my loans for the period during wh ich I have an economic hardship, as described 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 later of the date the deferment condition began or the date that I identify in Item 8 **3.** My deferment will end on the earlier of the date that the condition that establishes by deferment e ligibility ends or the certified deferment end date . **4.** My maximum cumulative eligibility for an Economic Hardship Deferment on my Direct Loan is 36 months. My maximum cumulative eligibility for an Economic Hardship Deferment on my FFEL Program loans is 36 months. **5.** Unless I am a Peace Corps volunteer, my deferm ent will be granted in increments of 1 year. If I continue to be eligible for an Economic Hardship Deferment after 1 year, I may reapply, subject to the cumulative maximum. **6.** 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. **7.** 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 forbeara nce 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, a nd meet the eligibility requirements of the 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** :

___ ___ - ___ ___ - ___ ___ ___ ___Page 3 of 5 **SECTION 4 :**  **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. Include your name an account number on any documentation 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 to each loan holder. **SECTION 5**  **: DEF**  **INITIONS Capitalization**  is the addition of unpaid interest to the principal balance of your loan. As a result of capitalization, more interest may accrue over the life of the loan and the monthly payment amount may be higher. The chart below (Table 2 ) provides estimates, for a $15,000 unsubsidized loan balance at a 6.8% interest rate, of the monthly payments due following 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 post pone 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 Federal Stafford Loan, or, in some cases, the subsidized portion of a Fed eral 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 Federal 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 application 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 Co nsolidation Loan that paid a subsidized Direct Loan or FFEL Program loan(s). **Family size** includes you, your spouse, your children if they receive more than half of their support from you, including unborn children who will be born during the deferment period, and other people if, at the time you request this deferment, they live with you, receive more than half their support from you, and will continue to receive this support from you for the deferment period. Support includes money, gifts, loans, housing, food, clothes, car, medical and dental care, and payment of college costs. The **Federal F amily Education Loan (FFEL)**  **Program** includes Federal Stafford Loans, Federal PLUS Loans, Federal Consolidation Loans, and Federal Supplem ental Loans for Students (SLS). The **Federal Perkins Loan (Perkins Loan) Program** includes Federal Perkins Loans, Nationa l Direct Student Loans (NDSL), and National Defense Student Loans (Defense Loans) A **forbearance** is a period during which you are permitted to temporarily postpone making payments, allowed an extension of time for making payments, or temporarily allowed to make smaller payments than scheduled. **Full -** **time employment** means working at least 30 hours per week in a position expected to last at least 3 consecutive months. The **holder** of your Direct Loan Program loan(s) is the Department . The holder of your FFEL Prog ram loan(s) may be a lender, guaranty agency, secondary market, or 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.Page 4 of 5 **SECTION 5**  **: DEFINITIONS (CONTINUED)**  Table 2. 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. **SECTION 6**  **: ELIGIBILITY REQUIREMENTS**  You are eligible for this deferment if you answer “yes” in Items 1, 2, or 3, or answer “yes” to Items 4 and 7 . For **Direct Loan borrowers** only, you are eligible for this deferment if you meet the criteria above, regardless of when you borrowe d your Direct Loans. For **FFEL Program borrowers** only, you are only eligible for this deferment if all of your FFEL Program loans were first disbursed on or after July 1, 1993, or if you had no balance on a FFEL Program loan that was disbursed before July 1, 1993 when you received a loan on or after July 1, 1993. **SECTION 7**  **: WHERE TO SEND THE COMPLETED FORM** Return the completed form to : If you need help completing this form, call:

**SECTION 8**  **: 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 collecting 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)) a nd 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 SS N, 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 t he 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 youPage 5 of 5 default . To provi de 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 progra m 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 circu mstances 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 unl ess 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, please contact your loan holder directly ( see Section 7 ) .