Supplemental Claim Form - Federal Family Education Loan Program Page 2
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2Instructions for Completing Supplemental Claim Form
This form is to be used to submit a request for increase in the amount of claim payment to the guarantor. When completing this form, print or type all information
and complete all applicable fields. Use the chart in the Common Manual titled “Information to be Provided on the Supplemental Claim Form” to identify which
fields are required and provide the requested information; for fields where the information is not available (or applicable), complete alpha fields with “NA” and fill
numeric/date fields with zeroes. All date fields must be completed with numerics in MM/DD/CCYY format. No supplemental claim may be submitted for an amount
less than fifty dollars ($50.00). If the number of claimed loans requires more space than is provided, attach a separate Supplemental Claim Form with only
Sections I and II completed.
I. BORROWER INFORMATION:
1.
Social Security #: Provide the borrower’s social security number (do not submit a Supplemental Claim Form without a social security number).
2.
Name (Last, First, MI): Provide the borrower’s last name, first name, and middle initial.
II. LOAN INFORMATION:
3.
Loan Type: For each loan listed, provide the loan type using one of the following codes: SF = Subsidized Stafford (including non-subsidized
disbursed prior to 10/92); SU = Unsubsidized Stafford; PL = PLUS; GB = Graduate PLUS; SL = SLS; CL = Consolidation. A separate Supplemental
Claim Form must be submitted for each loan type. Note: Subsidized and unsubsidized Stafford loans that have been combined into one repayment
schedule may be combined into one supplemental claim, subject to guarantor requirement.
4.
Loan ID: For each loan listed, provide the loan identifier code, file number, guarantee date, or guarantee amount, as required by the guarantor of
the loan(s).
5.
Int Rate/Type: For each loan listed, provide the current interest rate and indicate the type of interest rate by entering the appropriate code:
F = Fixed rate; V = Variable rate; 8 = Adjustable rate (8-10%).
III. CLAIM PAYMENT INFORMATION:
6.
$ Prin Paid: Provide the amount of principal paid by the guarantor.
7.
$ Int Paid: Provide the amount of interest paid by the guarantor.
8.
# Days Int Paid: Provide the number of days of interest paid by the guarantor (i.e., calculate the number of days between item 10 and the last date
through which the guarantor paid accrued interest).
9.
Claim Pmt Dt: Provide the date the claim payment was received.
10.
Int-Paid-Through Dt: Provide the date submitted on the claim form through which interest was last paid.
IV. REQUESTED SUPPLEMENTAL CLAIM AMOUNT:
11.
$ Prin Increase: Provide the amount of principal that was underpaid.
12.
$ Int Increase: Provide the amount of interest that was underpaid.
13.
$ Total Increase: Provide the total value of the supplemental claim (the sum of item 11 and 12).
V. REASON FOR SUPPLEMENTAL CLAIM REQUEST:
A. Due Diligence Error Incorrectly Cited
14.
DL: An interest penalty was incorrectly cited for missing letters. Supporting documentation: Applicable servicing and/or payment history.
15.
LD: An interest penalty was incorrectly cited for a missing final demand letter. Supporting documentation: Applicable servicing and/or payment
history.
16.
DK: An interest penalty was incorrectly cited for untimely and/or omitted telephone skip tracing activities. Supporting documentation: Applicable
servicing and/or payment history.
17.
DA: An interest penalty was incorrectly cited for an untimely and/or omitted diligent effort to contact the borrower by telephone. Supporting
documentation: Applicable servicing and/or payment history.
18.
DP: An interest penalty was incorrectly cited for a missing default aversion assistance request. Supporting documentation: Copy of a default aversion
assistance request acknowledgment or other documentation acceptable to the guarantor (e.g., signed hard-copy list of borrowers from a tape).
19.
DT: An interest penalty was incorrectly cited for untimely and/or omitted address skip tracing activities. Supporting documentation: Applicable
servicing and/or payment history.
20.
DC: An interest penalty was incorrectly cited for a late default aversion assistance request. Supporting documentation: Copy of a default aversion
assistance request acknowledgment or other documentation acceptable to the guarantor (e.g., a signed hard-copy list of borrowers from a tape).
21.
DO: Other due diligence errors were incorrectly cited. Supporting documentation: Applicable servicing and/or payment history or other loan
document.
B. Error in Interest Calculation
22.
IM: The number of days of interest paid was calculated incorrectly by the guarantor. Provide the correct number of days of interest that should have
been paid on the claim.
23.
IN: The return time frame was calculated incorrectly. Provide the date the lender received the returned claim package, and the resubmission date for
the return time frame in dispute. Provide supporting documentation.
24.
IP: An incorrect interest-paid-through date was used to calculate the claim payment amount. Provide the correct interest-paid-through date.
C. Miscellaneous
25.
MF: Incorrect information was provided on the original claim form. Supporting documentation: Applicable servicing and/or payment history or other
loan document.
26.
MT: A timely filing violation is being appealed. Supporting documentation: Applicable servicing and/or payment history.
27.
MO: Other miscellaneous supplemental request reasons. Supporting documentation: Applicable servicing and/or payment history or other loan
document.
D. Comments: Provide explanation of request as necessary.
VI. LENDER/SERVICER INFORMATION AND CERTIFICATION:
28.
Lender ID: Provide the six-digit Department of Education lender code and, as applicable, the four-digit non-Department of Education suffix of the
lender or the current holder.
29.
Servicer ID: If the account is being serviced, provide the six-digit Department of Education servicer code.
30.
Lender/Servicer Name: If the account is being serviced, provide the servicer’s name; if there is no servicer, provide the lender’s name.
31.
Lender/Servicer Address: If the account is being serviced, provide the servicer’s address; if there is no servicer, provide the lender’s address.
32.
Prepared By: Provide the name of the person or unit responsible for answering questions about information provided on this form.
33.
Preparer’s #: Provide the phone number (including area code) where the preparer may be reached.
07/ 06
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