OMB No. 1845-0018
Form Approved
Exp. Date 8/31/2021
William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family
Education Loan (FFEL) Program / Federal Perkins Loan (Perkins Loan) Program
: 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.
Please enter or correct the following information.
Check this box if any of your information has changed.
City State
Zip Code
Telephone - Primary
Telephone - Alternate
Email (Optional)
Carefully read the entire form before completing it. Complete Section 2 in its entirety. Maximum eligibility is 36
As an alternative to this forbearance, you may qualify for a deferment or for a repayment plan that sets your
payment amount based on your income. Visit
for more information on repayment plans based on
Do you currently have taxable income?
Multiply the amount in Item 2 by 20% (0.20):
Check "No" if you do not have any income or
only receive untaxed income.
Yes - Continue to Item 2.
What is the total amount of your monthly payments
No - Skip to Section 3.
on all of your Title IV loans? (See Section 5)
What is your total monthly taxable income?
You must attach documentation of your most
recent monthly payments due on each of your Title
Attach documentation of your monthly income,
IV loans, such as a monthly statement or repayment
such as a tax return, W-2s, paystubs, or dividend
statements. Monthly income is either (you choose):
Is the amount reported in Item 4 equal to or greater
than the amount calculated in Item 3?
Yes - Continue to Section 3.
Your gross taxable income from all sources; or
One-twelfth of the Adjusted Gross Income from
your most recent federal income tax return.
No - You are not eligible for this forbearance.
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Borrower Name Borrower SSN
I request:
My loan holder grant forbearance for the period during which I meet the qualifications for the forbearance. If
approved for a forbearance, I would like to:
Temporarily stop making payments; or
Make smaller payments in the amount of
per month.
My forbearance begin on the following date:
My loan holder grant my forbearance for up to 12 months unless I specify an earlier end date:
If checked, to make interest payments on my loans during forbearance.
I understand:
I am not required to make payments of loan principal or interest during forbearance.
My forbearance will begin on the later of the date my loan holder determines or the date I requested.
My loan holder may grant me a forbearance while processing my form or to cover any period of delinquency that
exists when I submit my form.
My forbearance will end on the earlier of the date I exhaust my maximum eligibility for the forbearance, 12 months
from the date my forbearance begins, on the date I am no longer eligible for the forbearance, or the end date I
My forbearance will only be granted in increments of up to 12 months, and I must reapply for the forbearance if I
continue to meet the eligibility requirements and want to extend my forbearance.
Interest may capitalize on my loans during or at the expiration of my forbearance, but interest never capitalizes on
Perkins Loans.
If I do not qualify for this forbearance, my loan holder may apply a discretionary forbearance for the same period if I
am eligible.
I certify that:
The information I have provided on this form is true and correct.
I will provide additional documentation to my loan holder, as required, to support my forbearance eligibility.
I will notify my loan holder immediately when my eligibility for the forbearance ends.
I have read, understand, and meet the eligibility requirements in Section 2.
I authorize
the entity to which I submit this request and its agents to contact me regarding my request or my loans at any
cellular telephone number that I provide now or in the future using automated telephone dialing equipment or artificial
prerecorded voice or text messages.
Borrower's or Endorser's Signature
Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Example: March 14, 2019 = 03-14-2019. Include
your name and account number on any documentation that you submit with this form. If you want to apply for a forbearance
on loans that are held by different loan holders, you must submit a separate forbearance request to each loan holder.
the completed form and any required documentation to the address shown in Section 6.
Endorsers may request forbearance only when you are required to repay the loan because the borrower is not making
payments. For those who have loans made jointly (as co-makers), both borrowers must individually meet the requirements
for a forbearance and each of you must submit a separate forbearance request.
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American Education Services
P.O. Box 2461
Harrisburg, PA 17105-2461
Fax: 717-720-3916
Phone: 800-233-0557
Or visit
Title IV loans
are student loans that you received
under the Direct Loan Program, the FFEL Program, and
the Perkins Loan Program.
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.
Federal Family Education Loan (FFEL) Program
includes Federal Stafford Loans, Federal PLUS Loans,
Federal Consolidation Loans, and Federal Supplemental
Loans for Students (SLS).
Federal Perkins Loan (Perkins Loan) Program
includes Federal Perkins Loans, National Direct Student
Loans (NDSL), and National Defense Student Loans
(Defense Loans).
is the addition of unpaid interest to the
principal balance of your loan. Capitalization causes more
interest to accrue over the life of your loan and may cause
your monthly payment amount to increase. Interest never
capitalizes on Perkins Loans. Table 1 (below) provides an
example of the monthly payments and the total amount
repaid for a $30,000 unsubsidized loan. The example loan
has a 6% interest rate and the example deferment or
forbearance lasts for 12 months and begins when the loan
entered repayment. The example compares the effects of
paying the interest as it accrues or allowing it to capitalize.
is one of the two individuals who are joint
borrowers on a Direct or Federal Consolidation Loan or a
Federal PLUS Loan. Both co-makers are equally
responsible for repaying the full amount of the loan.
Table 1. Capitalization Chart
is an individual who signs a promissory
note and agrees to pay the loan if the borrower does not.
is a period during which you are
allowed to postpone making payments temporarily,
allowed an extension of time for making payments, or
temporarily allowed to make smaller payments than
scheduled. A forbearance can be a mandatory
forbearance, meaning that your loan holder must grant
the forbearance if you qualify for the forbearance and
supply all supporting documentation. A forbearance can
also be a discretionary forbearance, meaning that your
loan holder may grant the forbearance, but is not required
to do so.
of your Direct Loans is the Department. The
holder of your FFEL Program loans may be a lender,
guaranty agency, secondary market, or the Department.
The holder of your Perkins Loans is an institution of higher
education 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.
subsidized loan
is a Direct Subsidized Loan, a Direct
Subsidized Consolidation Loan, a Federal Subsidized
Stafford Loan, and portions of some Federal Consolidation
unsubsidized loan
is a Direct Unsubsidized Loan, a
Direct Unsubsidized Consolidation Loan, a Direct PLUS
Loan, a Federal Unsubsidized Stafford Loan, a Federal
PLUS Loan, a Federal SLS, and portions of some Federal
Consolidation Loans.
Treatment of Interest with
Loan Amount
Number of
Total Repaid
Interest is paid $30,000 $0 $30,000 $333 120 $41,767
Interest is capitalized at the
$30,000 $1,800 $31,800 $353 120 $42,365
Interest is capitalized
quarterly and at the end
$30,000 $1,841 $31,841 $354 120 $42,420
Return the completed form and any documentation to: If you need help completing this form, call:
(If no address is shown, return to your loan holder.) (If no phone number is shown, call your loan holder.)
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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., or §461 of
the Higher Education Act of 1965, as amended (20 U.S.C.
1071 et seq., 20 U.S.C. 1087a et seq., or 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 William D. Ford Federal Direct
Loan (Direct Loan) Program, Federal Family Education Loan
(FFEL) Program, or Federal Perkins Loan (Perkins Loan)
Program and giving us your SSN are voluntary, but you must
provide the requested information, including your SSN, to
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, FFEL, or Federal Perkins
Loan Programs, 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
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 such
collection displays a valid OMB control number. The valid
OMB control number for this information collection is
1845-0018. Public reporting burden for this collection of
information is estimated to average 12 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 674.33, 682.211, or 685.205.
If you have comments or concerns regarding the
status of your individual submission of this form, please
contact your loan holder directly (see Section 6).
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