William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family
Education Loan (FFEL) Program / Federal Perkins Loan (Perkins Loan) Program.
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.
OMB No. 1845-0011
Form Approved
Exp. Date 9/30/2018
Please enter or correct the following information.
Check this box if any of your information has changed.
State Zip Code
Telephone - Primary
Telephone - Alternate
Email (Optional)
Carefully read the entire form before completing it. Complete Section 2 in its entirety.
1. Is your program licensed, approved, certified, or
recognized as providing rehabilitation training to
disabled individuals by the Department of Veterans
Affairs or a state agency responsible for vocational
rehabilitation, drug abuse treatment, mental health
treatment, or alcohol abuse treatment?
Yes - Continue to Item 2.
No - You are not eligible for this deferment.
2. Does your training program provide services under
a written, individualized plan that specifies the date
the services are expected to end?
Yes - Continue to Item 3.
No - You are not eligible for this deferment.
3. Does your program require a substantial
commitment by you to your rehabilitation?
Substantial commitment means a commitment
of time and effort that would normally prevent a
person from being employed 30 or more hours per
week in a position expected to last at least 3
Yes - Continue to Item 4.
No - You are not eligible for this deferment.
4. Are you receiving or scheduled to receive
vocational, drug abuse, mental health, or alcohol
abuse rehabilitation services in your program?
Yes - Complete Section 3 and then have an
authorized official complete Section 4.
No - You are not eligible for this deferment.
I request:
To defer repayment of my loans for the period during which I meet the eligibility criteria outlined in Section 2 and as
certified by an authorized official in Section 4.
If indicated, to make interest payments on my loans during my deferment.
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Borrower SSNBorrower Name
I understand that:
I am not required to make payments of loan principal or interest during my deferment.
My deferment will begin on the date I became eligible, as certified by the authorized official.
My deferment will end on the earlier of the certified deferment end date or when I am no longer eligible for the
deferment for another reason.
If I am a Perkins Loan borrower, I will receive a 6-month post-deferment grace period beginning on the date I no
longer qualify for the deferment.
Interest may capitalize on my loans during or at the expiration of my deferment or forbearance, but interest never
capitalizes on Perkins Loans.
I certify, to the best of my knowledge and belief, 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 deferment eligibility.
I will notify my loan holder immediately when my eligibility for the deferment 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 or
prerecorded voice or text messages.
Borrower's Signature
Do not complete this section unless the borrower has completed Section 2 in its entirety. Note: Instead of having an
authorized official complete this section, you may attach separate documentation from an authorized official that includes all
of the information requested below and a certification that you and the program meet all conditions indicated by your
responses in Section 2.
The program begins/began on:
The program is expected to end/ended on:
I certify, to the best of my knowledge and belief, that:
The borrower and the program meet all conditions indicated by the borrower's responses in Section 2; and
The information that I have provided in this section is accurate.
Name of Institution
Official's Name/Title
Official's Signature
OPEID (if applicable)
Zip CodeState
Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Example: March 14, 2015 = 03-14-2015. Include
your name and account number on any documentation that you are required to submit with this form. 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. Return the completed form and any required documentation to the address shown in Section 7.
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An authorized official who may complete Section 4 is
an official of the Rehabilitation Training Program.
Capitalization 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.
A deferment is a period during which you are entitled
to postpone repayment of your loans. Interest is not
generally charged to you during a deferment on your
subsidized loans. Interest is always charged to you during a
deferment on your unsubsidized loans. On loans made
under the Perkins Loan Program, all deferments are
followed by a post-deferment grace period of 6 months,
during which time you are not required to make payments.
The Federal Family Education Loan (FFEL) Program
includes Federal Stafford Loans, Federal PLUS Loans, Federal
Consolidation Loans, and Federal Supplemental Loans for
Students (SLS).
The Federal Perkins Loan (Perkins Loan) Program
includes Federal Perkins Loans, National Direct Student
Loans (NDSL), and National Defense Student Loans (Defense
The holder 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.
A subsidized loan is a Direct Subsidized Loan, a Direct
Subsidized Consolidation Loan, a Federal Subsidized
Stafford Loan, portions of some Federal Consolidation
Loans, Federal Perkins Loans, NDSL, and Defense Loans.
An 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.
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.
Table 1. Capitalization Chart
Treatment of Interest with
Loan Amt.
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 no address is shown, return to your loan holder.)
If you need help completing this form, call:
(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
1845-0011. 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 674.34, 674.35, 674.36, 674.37, 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).
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