Unemployment Deferment Request
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4UNEMPLOYMENT DEFERMENT REQUEST
OMB No. 1845-0011
Form Approved
William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family
Exp. Date 9/30/2018
Education Loan (FFEL) Program / Federal Perkins Loan (Perkins Loan) Program
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on
any accompanying document is subject to penalties that may include fines, imprisonment, or both, under
UNEM
the U.S. Criminal Code and 20 U.S.C. 1097.
SECTION 1: BORROWER INFORMATION
Please enter or correct the following information.
Check this box if any of your information has changed.
SSN
Name
Address
State
Zip Code
City
Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: BORROWER DETERMINATION OF DEFERMENT ELIGIBILITY
Carefully read the entire form before completing it. Complete Section 2 in its entirety. For most borrowers, maximum
eligibility is 36 months. For FFEL Program borrowers who have an outstanding balance on a FFEL Program loan first
disbursed before July 1, 1993 or who had an outstanding balance on a loan first disbursed before July 1, 1993 when receiving
a FFEL Program loan on or after July 1, 1993, maximum eligibility is 24 months.
1.
Are you receiving unemployment benefits?
4. Is this an extension of a previously granted
Unemployment Deferment?
If you answer yes, you must attach
Yes - Continue to Item 5.
documentation of your eligibility for these benefits
No - Skip to Item 6.
which:
• Includes your name, address, and Social Security
5. Have you made at least six diligent attempts to find
Number and
full-time employment in the most recent 6 months?
Yes - Continue to Item 6.
• Shows that you are eligible to receive the
benefits for the period of time for which you are
No - You are not eligible for this deferment
requesting a deferment.
unless
you are a Perkins Loan borrower. If you
are a Perkins Loan borrower, continue to Item 6.
Yes - Skip to Section 3.
No - Continue to Item 2.
6. Is there a public or private employment agency
within 50 miles of your current address?
2. Are you diligently seeking but unable to find full-
School placement offices, temporary
time employment (see Section 5) in the United
employment agencies, and Web sites that allow
States?
users to search or apply for employment do not
Yes - Continue to Item 3.
qualify.
No - You are not eligible for this deferment.
Yes - Continue to Item 7.
No - Skip to Section 3.
3. Have you rejected offers of full-time employment in
the United States in any field or at any salary or
7. Have you registered with the public or private
responsibility level because you were overqualified?
employment agency?
Yes - You are not eligible for this deferment
Yes - Continue to Section 3.
unless you are a Perkins Loan borrower. If you
No - You are not eligible for this deferment
are a Perkins Loan borrower, continue to Item 4.
unless you are a Perkins Loan borrower. If you
No - Continue to Item 4.
are a Perkins Loan borrower, continue to
Section 3.
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