Graduate Fellowship Deferment Request Form Page 4


Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C.
To assist program administrators with tracking refunds
552a) requires that the following notice be provided to you:
and cancellations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to
The authorities for collecting the requested information
federal or state agencies. To provide a standardized method
from and about you are §421 et seq., §451 et seq., or §461 of
for educational institutions to efficiently submit student
the Higher Education Act of 1965, as amended (20 U.S.C.
enrollment statuses, disclosures may be made to guaranty
1071 et seq., 20 U.S.C. 1087a et seq., or 20 U.S.C. 1087aa et
agencies or to financial and educational institutions. To
seq.) and the authorities for collecting and using your Social
counsel you in repayment efforts, disclosures may be made
Security Number (SSN) are §§428B(f) and 484(a)(4) of the
to guaranty agencies, to financial and educational
HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31 U.S.C.
institutions, or to federal, state, or local agencies.
7701(b). Participating in the William D. Ford Federal Direct
Loan (Direct Loan) Program, Federal Family Education Loan
In the event of litigation, we may send records to the
(FFEL) Program, or Federal Perkins Loan (Perkins Loan)
Department of Justice, a court, adjudicative body, counsel,
Program and giving us your SSN are voluntary, but you must
party, or witness if the disclosure is relevant and necessary
provide the requested information, including your SSN, to
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
The principal purposes for collecting the information on
send information to members of Congress if you ask them
this form, including your SSN, are to verify your identity, to
to help you with federal student aid questions. In
determine your eligibility to receive a loan or a benefit on a
circumstances involving employment complaints,
loan (such as a deferment, forbearance, discharge, or
grievances, or disciplinary actions, we may disclose relevant
forgiveness) under the Direct Loan, FFEL, or Federal Perkins
records to adjudicate or investigate the issues. If provided
Loan Programs, to permit the servicing of your loans, and, if
for by a collective bargaining agreement, we may disclose
it becomes necessary, to locate you and to collect and
records to a labor organization recognized under 5 U.S.C.
report on your loans if your loans become delinquent or
Chapter 71. Disclosures may be made to our contractors for
default. We also use your SSN as an account identifier and to
the purpose of performing any programmatic function that
permit you to access your account information
requires disclosure of records. Before making any such
disclosure, we will require the contractor to maintain Privacy
The information in your file may be disclosed, on a case-
Act safeguards. Disclosures may also be made to qualified
by-case basis or under a computer matching program, to
researchers under Privacy Act safeguards.
third parties as authorized under routine uses in the
Paperwork Reduction Notice. According to the
appropriate systems of records notices. The routine uses of
Paperwork Reduction Act of 1995, no persons are required
this information include, but are not limited to, its disclosure
to respond to a collection of information unless such
to federal, state, or local agencies, to private parties such as
collection displays a valid OMB control number. The valid
relatives, present and former employers, business and
OMB control number for this information collection is
personal associates, to consumer reporting agencies, to
1845-0011. Public reporting burden for this collection of
financial and educational institutions, and to guaranty
information is estimated to average 10 minutes per
agencies in order to verify your identity, to determine your
response, including time for reviewing instructions,
eligibility to receive a loan or a benefit on a loan, to permit
searching existing data sources, gathering and maintaining
the servicing or collection of your loans, to enforce the
the data needed, and completing and reviewing the
terms of the loans, to investigate possible fraud and to verify
collection of information. The obligation to respond to this
compliance with federal student financial aid program
collection is required to obtain a benefit in accordance with
regulations, or to locate you if you become delinquent in
34 CFR 674.34, 674.35, 674.36, 674.37, 682.210, or 685.204. If
your loan payments or if you default. To provide default rate
you have comments or concerns regarding the status of
calculations, disclosures may be made to guaranty agencies,
your individual submission of this form, please contact your
to financial and educational institutions, or to state
loan holder directly (see Section 7).
agencies. To provide financial aid history information,
disclosures may be made to educational institutions.
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