DD Form 2475 DoD Educational Loan Repayment Program (LRP) Annual Application

What Is DD Form 2475?

DD Form 2475, DoD Educational Loan Repayment (LRP) Annual Application is a form used by service members to request the Army to pay off a portion of their student loans. The provided information will be reviewed by the Military Service Personnel record custodian to verify that eligibility requirements are met.

The latest version of the form - sometimes incorrectly referred to as the DA Form 2475 - was released by the Department of Defense (DoD) in January 2014. An up-to-date DD Form 2475 fillable version is available for download and online filing below or can be found through the Executive Services Directorate website.

Filing the form is voluntary. However, failure to provide the necessary information will result in the DOD not being able to verify the amount and status of the loan and make the requested payments.

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LOAN PROGRAM
CONTROL NO.
(X one)
DOD EDUCATIONAL
OMB No. 0704-0152
ACTIVE DUTY LRP
LOAN REPAYMENT PROGRAM (LRP)
OMB approval expires
HEALTH PROFESSIONALS LRP
Jan 31, 2017
ANNUAL APPLICATION
SELECTED RESERVE LRP
The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, Alexandria,
VA 22350-3100 (0704-0152). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it
does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. FORWARD YOUR FORM TO THE ADDRESS LISTED IN SECTION 1, BLOCK a.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 2171, Education Loan Repayment Program: Enlisted Members on Active Duty in Specified Military Specialties; 2173, Education
Loan Repayment Program: Commissioned Officers in Specified Health Professions; 16301, Education Loan Repayment Program: Members of Selected
Reserve; 16302, Education Loan Repayment Program: Health Professions Officers Serving in Selected Reserve with Wartime Critical Medical Skill
Shortages; 16303, Loan Repayment Program: Chaplains Serving in the Selected Reserve, and E.O. 9397, Social Security Number (SSN).
PRINCIPAL PURPOSE(S): In completing this form, you are requesting your Military Service to pay a portion of your student loan(s). The information you
provide will be reviewed by Military Service personnel record custodians to verify that you meet eligibility requirements. This form will then be forwarded to
the lender that you identify for verification of the loan amount and status. The form is returned to the Service finance office to make the annual payment to
your lender. Collected information is covered by the Applicable Military Service System of Records Notice (SORN) for the Official Military Personnel File or
Military Records Jacket. These links can be found at: http://dpclo.defense.gov/privacy/SORNs/component/DOD_Component_Notices.html.
ROUTINE USE(S): To the lender (Department of Education, U.S. Public Health Service, or other financial institution) you identify so that the loan amount
and status can be verified. The lender returns the completed form to your unit for additional processing. To the Internal Revenue Service for the purpose of
reporting taxable income, and to the credit reporting agencies to assist in the recovery of any improper payments made toward delinquent debts owed by a
beneficiary or former beneficiary. The DoD Blanket Routine Uses found at http://privacy.defense.gov/blanket_uses.shtml may apply to this collection.
DISCLOSURE: Voluntary. However, if the requested information is not provided, DoD will not be able to verify the loan amount or status and make the
annual payment you are requesting. Your Social Security Number (SSN) is used to ensure accuracy of data involving the specified individual applicant. If
you do not provide your SSN, processing of your application may be delayed.
OFFICIAL MILITARY PERSONNEL FILES:
Air Force: http://dpclo.defense.gov/privacy/SORNs/component/airforce/F036_AF_PC_C.html
Army: http://dpclo.defense.gov/privacy/SORNs/component/army/A0600-8-104B_AHRC.html
Army National Guard: http://dpclo.defense.gov/privacy/SORNs/component/army/A0600-8-104b_NGB.html
Navy: http://dpclo.defense.gov/privacy/SORNs/component/navy/N01070-3.html
Marine Corps: http://dpclo.defense.gov/privacy/SORNs/component/usmc/M01070-6.html
1. PERSONNEL OFFICE VERIFICATION
(To be completed by the designated personnel officer)
b. VERIFYING OFFICIAL.
a. FORWARD COMPLETED FORM TO THIS ADDRESS (Include ZIP Code)
I certify that this servicemember has performed satisfactorily.
(1) NAME (Last, First, Middle Initial)
(2) SIGNATURE
(3) DATE SIGNED
(YYYYMMDD)
2. SERVICEMEMBER DATA
(To be completed by Servicemember or Borrower (if parent loan incurred for Servicemember's education - see instructions))
a. NAME (Last, First, Middle Initial)
b. ADDRESS (Street, City, State, and ZIP Code)
c. SOCIAL SECURITY NO.
d. TELEPHONE NO. (Include Area Code)
I authorize the release of my financial data by lender/holder to complete entries in Section 3.
g. DATE SIGNED
e. E-MAIL ADDRESS
f. SIGNATURE
(YYYYMMDD)
3. LOAN DATA
(To be completed by loan servicing agency)
a. NAME ON THE LOAN (Last, First, Middle Initial)
b. ORIGINAL DATE OF PROMISSORY NOTE (YYYYMMDD)
c. ORIGINAL LOAN AMOUNT
d. LOAN
e. LOAN ACCOUNT NUMBER
OF
LOANS
f. LOAN HOLDER NAME
g. LOAN HOLDER ADDRESS (Include ZIP Code)
h. TELEPHONE NUMBER
(Include Area Code)
i. LOAN IN DEFAULT (X one)
j. UNPAID PRINCIPAL BALANCE
k. OUTSTANDING BALANCE
l. IS THIS A CONSOLIDATED LOAN?
YES
NO
YES
NO
m. FEDERAL TAX IDENTIFICATION NO.
n. TYPE OF LOAN (See Instructions)
o. LOAN INTEREST
(1) CAPITALIZED
(2) CURRENT YEAR
$
$
p. NAME AND ADDRESS OF INSTITUTION WHERE PAYMENT IS TO BE SENT (Include ZIP Code)
q. LENDER ROUTING NUMBER
r. CERTIFYING OFFICER.
As an official of the holding institution, I verify that this information is correct and current. Copy of the promissory note is enclosed.
(1) NAME (Last, First, Middle Initial)
(2) TITLE
(3) SIGNATURE
(4) DATE SIGNED
(YYYYMMDD)
DD FORM 2475, JAN 2014
PREVIOUS EDITION IS OBSOLETE.
Adobe Designer 9.0
LOAN PROGRAM
CONTROL NO.
(X one)
DOD EDUCATIONAL
OMB No. 0704-0152
ACTIVE DUTY LRP
LOAN REPAYMENT PROGRAM (LRP)
OMB approval expires
HEALTH PROFESSIONALS LRP
Jan 31, 2017
ANNUAL APPLICATION
SELECTED RESERVE LRP
The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, Alexandria,
VA 22350-3100 (0704-0152). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it
does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. FORWARD YOUR FORM TO THE ADDRESS LISTED IN SECTION 1, BLOCK a.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 2171, Education Loan Repayment Program: Enlisted Members on Active Duty in Specified Military Specialties; 2173, Education
Loan Repayment Program: Commissioned Officers in Specified Health Professions; 16301, Education Loan Repayment Program: Members of Selected
Reserve; 16302, Education Loan Repayment Program: Health Professions Officers Serving in Selected Reserve with Wartime Critical Medical Skill
Shortages; 16303, Loan Repayment Program: Chaplains Serving in the Selected Reserve, and E.O. 9397, Social Security Number (SSN).
PRINCIPAL PURPOSE(S): In completing this form, you are requesting your Military Service to pay a portion of your student loan(s). The information you
provide will be reviewed by Military Service personnel record custodians to verify that you meet eligibility requirements. This form will then be forwarded to
the lender that you identify for verification of the loan amount and status. The form is returned to the Service finance office to make the annual payment to
your lender. Collected information is covered by the Applicable Military Service System of Records Notice (SORN) for the Official Military Personnel File or
Military Records Jacket. These links can be found at: http://dpclo.defense.gov/privacy/SORNs/component/DOD_Component_Notices.html.
ROUTINE USE(S): To the lender (Department of Education, U.S. Public Health Service, or other financial institution) you identify so that the loan amount
and status can be verified. The lender returns the completed form to your unit for additional processing. To the Internal Revenue Service for the purpose of
reporting taxable income, and to the credit reporting agencies to assist in the recovery of any improper payments made toward delinquent debts owed by a
beneficiary or former beneficiary. The DoD Blanket Routine Uses found at http://privacy.defense.gov/blanket_uses.shtml may apply to this collection.
DISCLOSURE: Voluntary. However, if the requested information is not provided, DoD will not be able to verify the loan amount or status and make the
annual payment you are requesting. Your Social Security Number (SSN) is used to ensure accuracy of data involving the specified individual applicant. If
you do not provide your SSN, processing of your application may be delayed.
OFFICIAL MILITARY PERSONNEL FILES:
Air Force: http://dpclo.defense.gov/privacy/SORNs/component/airforce/F036_AF_PC_C.html
Army: http://dpclo.defense.gov/privacy/SORNs/component/army/A0600-8-104B_AHRC.html
Army National Guard: http://dpclo.defense.gov/privacy/SORNs/component/army/A0600-8-104b_NGB.html
Navy: http://dpclo.defense.gov/privacy/SORNs/component/navy/N01070-3.html
Marine Corps: http://dpclo.defense.gov/privacy/SORNs/component/usmc/M01070-6.html
1. PERSONNEL OFFICE VERIFICATION
(To be completed by the designated personnel officer)
b. VERIFYING OFFICIAL.
a. FORWARD COMPLETED FORM TO THIS ADDRESS (Include ZIP Code)
I certify that this servicemember has performed satisfactorily.
(1) NAME (Last, First, Middle Initial)
(2) SIGNATURE
(3) DATE SIGNED
(YYYYMMDD)
2. SERVICEMEMBER DATA
(To be completed by Servicemember or Borrower (if parent loan incurred for Servicemember's education - see instructions))
a. NAME (Last, First, Middle Initial)
b. ADDRESS (Street, City, State, and ZIP Code)
c. SOCIAL SECURITY NO.
d. TELEPHONE NO. (Include Area Code)
I authorize the release of my financial data by lender/holder to complete entries in Section 3.
g. DATE SIGNED
e. E-MAIL ADDRESS
f. SIGNATURE
(YYYYMMDD)
3. LOAN DATA
(To be completed by loan servicing agency)
a. NAME ON THE LOAN (Last, First, Middle Initial)
b. ORIGINAL DATE OF PROMISSORY NOTE (YYYYMMDD)
c. ORIGINAL LOAN AMOUNT
d. LOAN
e. LOAN ACCOUNT NUMBER
OF
LOANS
f. LOAN HOLDER NAME
g. LOAN HOLDER ADDRESS (Include ZIP Code)
h. TELEPHONE NUMBER
(Include Area Code)
i. LOAN IN DEFAULT (X one)
j. UNPAID PRINCIPAL BALANCE
k. OUTSTANDING BALANCE
l. IS THIS A CONSOLIDATED LOAN?
YES
NO
YES
NO
m. FEDERAL TAX IDENTIFICATION NO.
n. TYPE OF LOAN (See Instructions)
o. LOAN INTEREST
(1) CAPITALIZED
(2) CURRENT YEAR
$
$
p. NAME AND ADDRESS OF INSTITUTION WHERE PAYMENT IS TO BE SENT (Include ZIP Code)
q. LENDER ROUTING NUMBER
r. CERTIFYING OFFICER.
As an official of the holding institution, I verify that this information is correct and current. Copy of the promissory note is enclosed.
(1) NAME (Last, First, Middle Initial)
(2) TITLE
(3) SIGNATURE
(4) DATE SIGNED
(YYYYMMDD)
DD FORM 2475, JAN 2014
PREVIOUS EDITION IS OBSOLETE.
Adobe Designer 9.0
4.
b. CANCELLED AMOUNT
c. DISBURSED AMOUNT
d. DATE OF DISBURSEMENT
a. ORIGINAL LOAN AMOUNT
(YYYYMMDD)
5. REMARKS
DD FORM 2475, "DOD EDUCATIONAL LOAN REPAYMENT PROGRAM (LRP) ANNUAL APPLICATION"
INSTRUCTIONS
SECTION 1. PERSONNEL OFFICE VERIFICATION
3.n. Type of Loan. Select from list below: The loan must qualify under the
(To be completed by the designated personnel officer.)
Higher Education Act of 1965, Title 4, Parts B, D, and E; the Health
Education Assistance Loan under Part C, Title VII, Public Health Service Act;
1.a. - b. Self-explanatory.
under Part B, Title VIII; Health Professional Loans that the SECDEF
determines to be critical to meet wartime medical skill shortages; William D.
Ford Federal Direct Loan; or any loan incurred for educational purposes
SECTION 2. SERVICEMEMBER DATA
made by a lender that is: (1) an agency or instrumentality of a State; (2) a
(To be completed by Servicemember or Borrower.)
financial or credit institution (including an insurance company) that is subject
to examination and supervision by an agency or the United States or any
2.a. - g. Servicemember or Borrower must complete. If the
State; or (3) from a pension fund or a non-profit private entity (subject to
Borrower is the parent and has a Parent Loan for
case-by-case review/approval by the
Undergraduate Students incurred for the Servicemember's
Office of the Undersecretary of Defense for Personnel and Readiness
education, please ensure the Servicemember's full name
(Military Personnel Policy) (Accession Policy) through each Service's
and last 4 digits of their SSN are provided in Section 5,
Education Representatives).
Remarks.
NOTE: For eligible LRP participants - Parent Loans for Undergraduate
Students (PLUS) and Consolidated Loans are also eligible for repayment
SECTION 3. LOAN DATA
under the LRP, as long as the loans were incurred for the Servicemember's
(To be completed by loan servicing agency.)
education. Since the loans may be in someone else's name and could
include loans incurred for individual's education other than the
3.a. Name as it appears on the promissory note.
Servicemember (such as a sibling or loans incurred for their own education),
3.b. - c. Self-explanatory.
it would be necessary to have the borrower complete Section 2 and include
3.d. Loan ___ of ___ Loans. A separate DD Form 2475
information regarding the education for which the loans were incurred.
must be completed for each loan if Borrower has more
3.o. Self-explanatory.
than one (1) loan. For example, loan 1 of 3 loans, loan 2
3.p. Complete this block only if different than the one listed in 3.f. and 3.g.
of 3 loans, and loan 3 of 3 loans.
3.q. Lender may not use a routing number as the payment address.
3.e. Loan Account Number to be used to ensure payments
3.r. Self-explanatory.
are applied to the correct amount.
3.f. - h. Identify the name, address, and telephone number
SECTION 4. LOAN DATA (To be completed by loan servicing agency.)
of the institution that currently services the loan. Please
4.a. Self-explanatory.
list any additional contact information in Section 5,
4.b. Amount cancelled after Origination Date of Loan.
Remarks.
4.c. Self-explanatory.
3.i. Mark X in the appropriate box.
4.d. Date of each individual disbursement.
3.j. Self-explanatory.
3.k. Self-explanatory.
SECTION 5. REMARKS.
3.l. If multiple loans have been consolidated, mark (X)
Use this section to enter additional information that will assist in processing
"Yes"
this application.
or "No" indicating consolidating action.
3.m. Provide Federal tax identification number for tax
After completion and signature, please return form to the address listed in
withholding.
Section 1.a.
DD FORM 2475 (BACK), JAN 2014

Download DD Form 2475 DoD Educational Loan Repayment Program (LRP) Annual Application

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How to Fill Out DD Form 2475?

The application consists of three main parts with an overview of the required information at the bottom of the second page. Additional guidelines and tips can be found in the Army Regulation 621-202, Army Educational Incentives and Entitlements, released in February 2016. DD Form 2475 instructions are as follows:

  1. Section I is the Personnel Office Verification. This section is completed by a designated personnel officer. It requires the address where the completed form is forwarded to along with the name and signature of a verifying official and the date of signing.
  2. Section II - Servicemember Data - is to be completed by the service member filing for assistance. The personal identifying data includes the name, SSN, home address and email address of the service member along with their signature and date of filing.
  3. The service member's full name and the last 4 digits of their SSN must be provided in Section V, Remarks if the Borrower is the parent and has a Parent Loan for Undergraduate Students incurred for the servicemember's education.
  4. Section III - Loan Data - is to be completed by the loan servicing agency.
    • Box A requires the name as it appears on the promissory note.
    • Box B requires the original date of the promissory note in YYYYMMDD format.
    • Box C is for the original loan amount.
    • Box D is for the overall number of loans.
    • Box E is for the loan account number that is to be used to ensure payments are applied to the correct amount.
    • Boxes F through H require the name, address, and telephone number of the institution that currently services the loan.
    • Box I is for the loan in default.
    • Box J is for the unpaid principal balance.
    • Box K requires stating the outstanding balance.
    • Box L questions whether the loan is consolidated.
    • Box M requires the Federal Tax Identification number.
    • Box N requires to define the type of loan. The full list of loan types can be found at the bottom of the form.
    • Box O is for specifying the loan interest.
    • Box P is to be filled with the name and address of the institution where payments are to be sent.
    • Box Q is to be completed with the lender routing number.
    • Box R is for verification from the certifying officer, with boxes for their name, title, signature, and date.
  5. Section IV consists of four columns that have to do with loan data and must also be completed by the loan servicing agency.
  6. Section V is for any extra remarks. These include any additional information that might assist in processing the application.

The completed and signed DD 2475 form is to be sent to the address listed in Section I, Box A.

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