Fillable Form Rfh-Awg Dcsi-010 - Request For Hearing (Page 3 of 3) in pdf

REQUEST FOR HEARING

(

) I

(or, for parent PLUS borrowers, the student) used

this

loan

enroll

____________________________________(school) on or about

___/___/___ and was unable to complete

the education because the school closed. (Obtain and submit a completed Loan Discharge Application:

School Closure form. ENCLOSE: any records you have showing your (or, for parent PLUS borrowers, the

student’s)

withdrawal date.) For loans only.

9. ( ) This is not my Social Security Number, and I do not owe this debt. (ENCLOSE: a copy of your

driver’s license or other identification issued by a Federal, state or local government agency, and a copy

of your Social Security Card.)

10. ( ) I believe that this debt is not an enforceable debt in the amount stated for the reason explained in

the attached letter. (Attach a letter explaining any reason other than those listed above for your objection

to collection of this debt amount by garnishment of your salary. ENCLOSE: any supporting records.)

11. ( ) I (or, for parent PLUS borrowers, the student) did not have a high school diploma or GED when I (or,

enrolled at the school attended with this guaranteed student loan.

for parent PLUS borrowers, the student)

The school did not properly test my (or, for parent PLUS borrowers, the student’s) ability to benefit from the

training offered. (Obtain and submit a completed Loan Discharge Application: False Certification (Ability

to Benefit) form. ENCLOSE: any records you have showing your withdrawal date.) For loans only.

12. ( ) When

borrowed

this

guaranteed

student

loan

attend

__________________________(school), I (or, for parent PLUS borrowers, the student) had a condition

(physical, mental, age, criminal record) that prevented me (or, for parent PLUS borrowers, the student) from

meeting State requirements for performing the occupation for which the school training was provided.

(Obtain and submit completed Loan Discharge Application: False Certification (Disqualifying Status) form.

For loans only.

13. ( ) I was involuntarily terminated from my last employment and I have been employed in my current

job for less than twelve months. (Attach statement from employer showing date of hire in current job and

statement from prior employer showing involuntary termination.)

14. ( ) I believe that __________________________________________________ (name of individual or

other party) without my permission signed my name or used my personal identification data to execute

documents to obtain this loan, and I did not receive the loan funds. (Obtain and submit a completed False

Certification (Unauthorized Signature/Unauthorized Payment) discharge application or Identity Theft

Certification). Enclose any records showing your withdrawal date). For loans only.

IV. I state under penalty of law that the statements made on this request are true and accurate to

the best of my knowledge.

DATE: _____________ SIGNATURE: _____________________________________________________________

SEND THIS REQUEST FOR HEARING FORM TO:

US DEPARTMENT OF EDUCATION

ATTN: AWG HEARINGS BRANCH

PO BOX 5227

GREENVILLE TX 75403-5227

If you wish to arrange a voluntary agreement for payments in amounts equal to 15% of your disposable

pay, do not use this form. Instead, call the Customer Service telephone number below:

U.S. Department of Education Customer Service

1-800-621-3115

Violation of any such agreement may result in an immediate order to your employer for garnishment of

15% of your disposable pay.

This is an attempt to collect a debt and any information obtained will be used for that purpose.

v04 (280) Rev. 09/2011

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RFH -AWG DCSI-010

Form Rfh-Awg Dcsi-010 - Request For Hearing Page 3

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