SECTION 7: WHERE TO SEND THE COMPLETED APPLICATION
Return the completed application and any documentation to:
(If no address is shown, return to your loan holder.)
If you need help completing this application, call:
(If no telephone number is shown, call your loan holder.)
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., §451 et seq., and §461
et seq. of the Higher Education Act of 1965, as amended (20
U.S.C. 1071 et seq., 20 U.S.C. 1087a et seq., and 20 U.S.C.
1087aa 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)) and 31
U.S.C. 7701(b). Participating in the Federal Family Education
Loan (FFEL) Program, the William D. Ford Federal Direct
Loan (Direct Loan) Program, or the Federal Perkins Loan
(Perkins 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, Direct Loan Programs, and/or
Perkins Loans to permit the servicing of your loans, and, if it
becomes necessary, to locate you and to collect and report
on your loans if your loans become delinquent or default.
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 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 loans, to enforce the
terms of the loans, 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 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 information collection is 1845-0058. Public reporting
burden for this collection of information is estimated to
average 30 minutes per response, including time for
reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and
completing and reviewing the information collection. The
obligation to respond to this collection is required to obtain
or retain a benefit (34 CFR 674.33(g)(4), 682.402(d)(3), or
685.214(c)). If you have comments or concerns regarding
the status of your individual submission of this form,
contact your loan holder directly.
Page 5 of 5
LS850-ZSPT
800-233-0557
AES - Loan Servicing
P.O. Box 2461
Harrisburg, PA 17105-2461
