Alternative Documentation Of Income - Gsmr (Page 2 of 2) in pdf

Section 5: Instructions and Where to Send the Completed Form

INSTRUCTIONS:

YOU ARE REQUIRED to complete this form if you are repaying your Direct Loans under the Income Contingent Repayment (ICR) or the Income-Based Repayment (IBR)

Plan and:



You are in your first year of repayment;



You are in your second year of repayment and have been notified that alternative documentation of your income is required; or



You have been notified that the Internal Revenue Service (IRS) is unable to provide the U.S. Department of Education (the Department) with your Adjusted Gross

Income (AGI) or that of your spouse (if applicable).

YOU MAY complete this form if:



You are repaying your Direct Loans under the ICR Plan and your AGI (and your spouse’s AGI, if you are married), as reported on your most recently filed federal tax

return, does not reasonably reflect your current income (e.g., due to circumstances such as loss or change in employment by you or your spouse).



You are repaying your Direct Loans under the IBR Plan and your AGI (and your spouse’s AGI, if you and your spouse file a joint federal tax return), as reported on

your most recently filed federal tax return, does not reasonably reflect your current income (e.g., due to circumstances such as loss or change in employment by you

or your spouse).

In cases where alternative documentation of your income is used, the amount of your monthly payment under the ICR or IBR Plan is based on the current income information

you and your spouse (if applicable) provide and is reevaluated annually. Your monthly payment may be adjusted more frequently than annually if you notify your servicer that

your AGI (or your spouse’s AGI, if you file a joint federal tax return) has changed significantly since your most recent submission of this form and you provide supporting

documentation showing this change. To submit alternative documentation of your income, you must attach the required documentation, complete and sign this form, and

return it to the address below. If you are married, your spouse must also complete and sign the applicable sections of this form and submit the required documentation if (1)

you are repaying your loans under the ICR Plan, or (2) you are repaying your loans under the IBR Plan and you and your spouse file a joint federal tax return. If you need

1-888-556-0022.

assistance, please call

Return this form to:

Granite State Management & Resources (GSM&R)

4 Barrell Court

PO Box 3420

Concord, NH 03302-3420

If you need assistance in completing this form, call 1-888-556-0022.

Section 6: 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 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

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 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 Direct Loan Program, 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) become delinquent or in 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 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 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 status, 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

currently valid OMB control number. The valid OMB control number for this information collection is 1845-0016. The time required to complete this information collection is

estimated to average 0.33 hours (20 minutes) per response, including the time to review instructions, search existing data resources, gather and maintain the data needed,

and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form,

please write to: U.S. Department of Education, Washington, DC 20202-4537. Do not send the completed form to this address.

If you have questions about the status of your individual submission of this form, contact your servicer at the following address:

Granite State Management & Resources (GSM&R)

4 Barrell Court

PO Box 3420

Concord, NH 03302-3420