Rehabilitation Training Deferment Request Form
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4REHABILITATION TRAINING 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
RHT
any accompanying document is subject to penalties that may include fines, imprisonment, or both, under
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
City
State
Zip Code
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.
1. Is your program licensed, approved, certified, or
3. Does your program require a substantial
recognized as providing rehabilitation training to
commitment by you to your rehabilitation?
disabled individuals by the Department of Veterans
Substantial commitment means a commitment
Affairs or a state agency responsible for vocational
of time and effort that would normally prevent a
rehabilitation, drug abuse treatment, mental health
person from being employed 30 or more hours per
treatment, or alcohol abuse treatment?
week in a position expected to last at least 3
Yes - Continue to Item 2.
months.
No - You are not eligible for this deferment.
Yes - Continue to Item 4.
No - You are not eligible for this deferment.
2. Does your training program provide services under
a written, individualized plan that specifies the date
the services are expected to end?
4. Are you receiving or scheduled to receive
vocational, drug abuse, mental health, or alcohol
Yes - Continue to Item 3.
abuse rehabilitation services in your program?
No - You are not eligible for this deferment.
Yes - Complete Section 3 and then have an
authorized official complete Section 4.
No - You are not eligible for this deferment.
SECTION 3: BORROWER REQUESTS, UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION
I request:
• To defer repayment of my loans for the period during which I meet the eligibility criteria outlined in Section 2 and as
certified by an authorized official in Section 4.
If indicated, to make interest payments on my loans during my deferment.
•
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