Income-Driven Repayment Plan Request Form - U.s. Department Of Education Page 2
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10SECTION 3: SPOUSAL INFORMATION
Complete this section if any of the following apply to you:
You file a joint federal income tax return with your spouse and your spouse has eligible loans.
You have a joint Direct or FFEL Consolidation Loan that you obtained with your spouse as a co-borrower.
You and your spouse have Direct Loans and both of you want to repay those loans under the ICR Plan.
3. Spouse’s SSN
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4. Spouse’s Name
5. Spouse’s Date of Birth
6.
My spouse and I want to repay our Direct Loans jointly under the ICR Plan.
If you complete this section, your spouse must also sign this form. By signing, your spouse is authorizing your loan holder
to access information about his or her federal student loans in the National Student Loan Data System (NSLDS). If your
spouse has FFEL Program loans that are not held by your loan holder, your spouse may need to give your loan holder
access to his or her loan information in NSLDS (nslds.ed.gov). For more information, contact your loan holder.
SECTION 4: FAMILY SIZE AND FEDERAL TAX INFORMATION
7.
Enter your family size (see Section 9; if you leave this blank, your loan holder will use a family size of one).
8. Did you file a federal income tax return in either of the two most recently completed tax years?
Yes – Continue to Item 9.
No – Skip to Section 5.
9. Is your current income or your spouse’s current income (if you completed Section 3 or if you file a joint federal
income tax return) significantly different than the income reported on your most recent federal income tax return?
Yes – Continue to Section 5.
No – Provide your most recent federal income tax return or transcript. Skip to Section 6.
SECTION 5: ALTERNATIVE DOCUMENTATION OF INCOME
Complete this section if you (1) answered “No” to Question 8, (2) answered “Yes” to Question 9, or (3) if your loan
holder requires you to provide alternative documentation of income.
10. Do you currently have taxable income? Check “No” if you do not have any income or receive only untaxed income.
Yes – Provide documentation of this income, as described below.
No – By signing this form, you are certifying that you do not have any taxable income.
11. If you completed Section 3 or file a joint federal income tax return with your spouse, does your spouse currently
have taxable income? Check “No” if your spouse does not have any income or receives only untaxed income.
Yes – Provide documentation of your spouse’s income, as described below.
No – By signing this form, your spouse is certifying that he or she does not have any taxable income.
If you answered “Yes” to Items 10 or 11, below are instructions on how to document your income:
You must provide documentation of all taxable income that you and your spouse (if applicable) currently receive (for
example, income from employment, unemployment income, dividend income, interest income, tips, alimony). Do
not report untaxed income such as Supplemental Security Income, child support, or federal or state public
assistance.
You must provide one piece of documentation for each source of taxable income. Documentation may include a pay
stub, a letter from your employer listing pay, bank statements, or dividend statements. If documentation is
unavailable, attach a signed statement explaining the income source(s) and giving the name and the address of the
income source(s).
Unless the frequency is clearly indicated on the documentation that you provide, write on your documentation how
often you receive the income, for example, “twice per month” or “every other week”. The date on any supporting
documentation you provide must be no older than 90 days from the date you sign this form. Copies of original
documentation are acceptable.
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