Fillable Forbearance Fgreement Form (Page 2 of 2) in pdf

Texas Higher Education Coordinating Board

Student Loan Program Operations

1200 East Anderson Lane, Austin, Texas 78752

P.O. Box 12788, Austin, Texas 78711

800/242-3062 512/427-6340 Fax 512/427-6570

FORBEARANCE AGREEMENT

Privacy Act Disclosure Notice

The authority for collecting this information is Chapter 52 of the Texas Education Code. The

principal purpose for collecting this information is to determine whether you are eligible for

forbearance on your loan(s) under the Hinson-Hazlewood College Student Loan Program.

We ask that you provide the information requested on this forbearance request on a voluntary

basis. However, you must provide all of the requested information so that we can determine

whether you qualify for forbearance.

The information in your file may be disclosed to third parties only as authorized under the

Family Education Rights and Privacy Act of 1974 (FERPA) (20 U.S.C. §1232g). FERPA allows

disclosure of personally identifiable record information, without consent of the individual,

contained by an educational agency only insofar as allowed by 34 CFR §99.31. We may disclose

personally identifiable information from an education record of a borrower without consent

required if: (1) The disclosure is, subject to certain conditions, to officials of another school,

school system, or institution of postsecondary education where the borrower seeks or intends to

enroll; (2) the disclosure is, subject to certain conditions, to authorized representatives of (i)

the Comptroller General of the United States; (ii) the Attorney General of the United States; (iii)

the Secretary; or (iv) State and local educational authorities; (3) the disclosure is in connection

with financial aid for which the borrower has applied or received, if the information is necessary

for such purposes as to: (A) determine eligibility for the aid; (B) determine the amount of the

aid; (C) determine the conditions for the aid; or (D) enforce the terms and conditions of the

aid; (4) the disclosure is to organizations conducting studies for, or on behalf of, educational

agencies or institutions to: (A) develop, validate, or administer predictive tests; (B) administer

borrower aid programs; or (C) improve instruction; (5) the disclosure is to comply with a judicial

order or lawfully issued subpoena; (6) the disclosure is made in connection with a legal action,

initiated by us, against the borrower, in which instance we may disclose to the court, without a

court order or subpoena, the records of the borrower that are relevant for us to proceed with

the legal action as plaintiff.

Because we request your social security number (SSN), we must inform you that we collect

your SSN on a voluntary basis, but in order to receive any grant, loan, or work assistance under

the Hinson-Hazlewood College Student Loan Program, a borrower must provide his or her SSN.

Your SSN is used to verify your identity, and as an account number (identifier) throughout the

life of your loan(s) so that data may be recorded accurately.

In addition to the foregoing, you have a right to have incorrect information contained in our

records pertaining to you corrected. See 19 TAC §§1.80-1.83 for the procedure to request such

a correction.

Forbearance Fgreement Form Page 2