Economic Hardship/unemployment Deferment Or Forbearance Request Template Page 2
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1
2
3
4Residents of Alaska
a.
Family of one
$1,195.85
b.
Number of Dependents (if any)
__________X $419.17 =
$_____________
c.
Total of 5a +5b =
$_____________
d.
150% of the poverty line
Total from 5c $__________x1.5 =
$_____________
Residents of Hawaii
a.
Family of one
$1,102.50
b.
Number of Dependents (if any)
__________X $385.00 =
$_____________
c.
Total of 5a+5b =
$_____________
d.
150% of the poverty line
Total from 5c $__________x1.5 =
$_____________
Annual poverty line guidelines, as defined by Section 673(2) of the Community Service Block Grant Act, is available at:
Yes. My total monthly gross income has been less than the annual poverty line (from 5d) since ____________.
Send your last two (2) pay stub and evidence of any other income. If this is not your first request for economic hardship, include a copy of
your most recent Federal Income Tax Return. Continue to Question 12.
No. Continue to Question 6.
6.
My total monthly gross income is equal to or less than twice the amount of 150% of the poverty line.
a.
Multiply the amount from 5D by 2 =
(5d x 2 =)
$_____________
b.
My Monthly Gross income is
$_____________
c.
Subtract 6b from 6a =
(6a-6b =)
$_____________
Is the result in Question 6c less than the amount in 5d?
Yes. Continue to Question 7.
No. You do not qualify for an Economic Hardship Deferment. You may still qualify for forbearance. Complete question 7 and continue to
Question 9.
7.
Calculate your total monthly Federal education loan payments. Monthly payments on loans in default can be included.
Is this loan currently in Forbearance? YES
NO
a.
Monthly payment amount for all Federal loans.
Federal Stafford Loan (subsidized and unsubsidized)
$_____________
Federal Direct Stafford Loan (subsidized and unsubsidized)
$_____________
Federal PLUS Loan
$_____________
Federal Direct PLUS Loan
$_____________
Federal Consolidation Loan/Federal Direct Consolidation Loan
$_____________
Federal Perkins Loan and/or National Direct Student Loan
$_____________
7a. Subtotal
7a
$_____________
Is this loan currently in Forbearance? YES
NO
b.
Monthly payment amount for all Federal loans.
Health Education Assistance Loan
$_____________
Nursing Student Loan
$_____________
Health Profession Loan
$_____________
7b. Subtotal
7b
$_____________
7c. Total
(7a+7b=7c)
7c Total:
7c
You must provide evidence showing monthly installment amounts.
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