ECONOMIC HARDSHIP DEFERMENT REQUEST
OMB No. 1845-0011
William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family Education Loan (FFEL) Program
Exp. Date 7/31/2015
Direct Loan Program borrowers: All borrowers are eligible.
FFEL Program borrowers: Use this form only 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 first
disbursed before July 1, 1993 when you obtained a loan on or after July 1, 1993.
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.
SECTION 1: BORROWER IDENTIFICATION
Please enter or correct the following information.
Check this box if any of your information has changed.
City, State, Zip Code
E-mail Address (Optional)
SECTION 2: DEFERMENT REQUEST
Before completing this form, carefully read the entire form, including the instructions and other information in Sections 4, 5, and 6.
I meet the eligibility requirements stated in Section 6 for the Economic Hardship Deferment checked below and request that my loan holder defer repayment of my loan(s)
(You must provide this date regardless of which condition you check below.)
To qualify, I must meet one of the conditions listed below and must provide the required documentation, as described in Section 6, for only that condition.
I have been granted an Economic Hardship Deferment on loans made under another federal student loan program for the same period of time for which I am requesting this
deferment. If this deferment request is for:
Direct Loan Program Loans, I have been granted the deferment under the FFEL or Federal Perkins Loan Program. I have attached documentation of the deferment.
FFEL Program Loans, I have been granted the deferment under the Direct Loan or Federal Perkins Loan Program. I have attached documentation of the deferment.
I am receiving or received payments under a federal or state public assistance program that support the period of time for which I am requesting this deferment. These
assistance programs include, but are not limited to, Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), Food Stamps/Supplemental
Nutritional Assistance Program (SNAP), or state general public assistance. I have attached documentation of these payments.
I am serving as a Peace Corps volunteer. I have attached documentation certifying my period of service in the Peace Corps.
I work full time (as defined in Section 5) and my monthly income does not exceed the larger of:
(A) Federal Minimum Wage Rate (monthly amount, based on $7.25 an hour): $1,256.67; or
(B) 150% of the poverty guideline for my family size and state: This amount is listed in Section 6.
My monthly income (as defined in Section 5) is $ ____________. I have attached documentation of this income.
My family size (as defined in Section 5) is ____________.
SECTION 3: BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION
I understand that:
(1) I am not required to make payments of loan principal during my deferment. Interest will not accrue on my subsidized loan(s) during my deferment. However, interest will accrue
on my unsubsidized loan(s).
(2) I may pay the interest that accrues on my unsubsidized loan(s) during my deferment. I may choose to make interest payments by checking the box below. My loan holder may
capitalize interest that I do not pay during the deferment period on my unsubsidized loan(s).
I wish to make interest payments on my unsubsidized loan(s) during my deferment.
(3) My deferment will begin on the date the deferment condition began.
(4) My deferment will end on the earlier of the date that the condition that establishes my deferment eligibility ends or the certified deferment end date.
(5) My maximum cumulative eligibility for an Economic Hardship Deferment on my Direct Loans is 36 months. My maximum cumulative eligibility for an Economic Hardship
Deferment on my FFEL Program Loans is a 36 months. Except for a deferment based on condition (3), as described in Section 2, I must reapply every 12 months if I continue
to meet the requirements for an Economic Hardship Deferment.
(6) If my deferment does not cover all my past due payments, my loan holder may grant a forbearance on my loan(s) for all payments due before the begin date of my deferment.
If the period for which I am eligible for a deferment has ended, my loan holder may grant a forbearance on my loan(s) for all payments due when my deferment request is
processed. Interest that accrues during this forbearance may be capitalized.
(7) My loan holder may grant a forbearance on my loan(s) for up to 60 days, if necessary, for the collection and processing of documentation related to my deferment request.
Interest that accrues during this forbearance 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 notify my loan holder immediately when the condition that qualified me for the deferment ends. (4) I have read, understand, and meet the eligibility
requirements of the deferment for which I have applied, as explained in Section 6.
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.
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