"Unemployment Deferment Request"

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UNEMPLOYMENT 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.
Page 1 of 4
UNEMPLOYMENT 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.
Page 1 of 4
Borrower Name
Borrower SSN
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 in Section 2.
• That my deferment begin on the date I became unemployed or
began working less than full time unless I provide a later date:
If indicated, to make interest payments during deferment.
I understand that:
• I am not required to make payments of loan principal or interest during my deferment.
• My deferment will begin on the later of the date I became eligible for the deferment or the date I requested.
• If I am a Direct Loan or FFEL Program borrower, my deferment will end on the earlier of the date I exhaust my
maximum eligibility for the deferment, 6 months from the date my deferment begins, or on the date I am no longer
eligible for the deferment for another reason.
• If I am a Perkins Loan borrower, my deferment will end on the earlier of the date I exhaust my maximum eligibility for
the deferment, 12 months from the date my deferment begins, or on the date I am no longer eligible for the
deferment for another reason.
• If I am a Perkins Loan borrower, I will receive a 6-month post-deferment grace period beginning on the date I no
longer qualify for the deferment.
• Interest may capitalize on my loan during or at the expiration of my deferment or forbearance, but interest never
capitalizes on a Perkins Loan.
• Instead of deferment, I may be eligible for a repayment plan that determines my monthly payment amount based on
my income and that I can visit
StudentAid.gov/IDR
for more information.
I certify that:
• I became unemployed or began working less than full time on:
• The information I have provided on this form is true and correct.
I will provide additional documentation to my loan holder, as required, to support my deferment eligibility.
• I will notify my loan holder immediately when my eligibility for the deferment ends.
• I have read, understand, and meet the eligibility requirements in Section 2.
I authorize the entity to which I submit this request and its agents to contact me regarding my request or my loans at any
cellular telephone number that I provide now or in the future using automated telephone dialing equipment or artificial or
prerecorded voice or text messages.
Date
Borrower's Signature
SECTION 4: INSTRUCTIONS FOR COMPLETING THE DEFERMENT REQUEST
Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Example: March 14, 2015 = 03-14-2015. Include
your name and account number on any documentation that you are required to submit with this form. If you want to apply
for a deferment on loans that are held by different loan holders, you must submit a separate deferment request to each loan
holder. Return the completed form and any required documentation to the address shown in Section 6.
Page 2 of 4
SECTION 5: DEFINITIONS
Capitalization is the addition of unpaid interest to the
The holder of your Direct Loans is the Department. The
principal balance of your loan. Capitalization causes more
holder of your FFEL Program loans may be a lender,
interest to accrue over the life of your loan and may cause
guaranty agency, secondary market, or the Department. The
your monthly payment amount to increase. Interest never
holder of your Perkins Loans is an institution of higher
capitalizes on Perkins Loans. Table 1 (below) provides an
education or the Department. Your loan holder may use a
example of the monthly payments and the total amount
servicer to handle billing and other communications related
repaid for a $30,000 unsubsidized loan. The example loan
to your loans. References to “your loan holder” on this form
has a 6% interest rate and the example deferment or
mean either your loan holder or your servicer.
forbearance lasts for 12 months and begins when the loan
A subsidized loan is a Direct Subsidized Loan, a Direct
entered repayment. The example compares the effects of
Subsidized Consolidation Loan, a Federal Subsidized
paying the interest as it accrues or allowing it to capitalize.
Stafford Loan, portions of some Federal Consolidation
A deferment is a period during which you are entitled
Loans, Federal Perkins Loans, NDSL, and Defense Loans.
to postpone repayment of your loans. Interest is not
An unsubsidized loan is a Direct Unsubsidized Loan, a
generally charged to you during a deferment on your
Direct Unsubsidized Consolidation Loan, a Direct PLUS
subsidized loans. Interest is always charged to you during a
Loan, a Federal Unsubsidized Stafford Loan, a Federal PLUS
deferment on your unsubsidized loans. On loans made
Loan, a Federal SLS, and portions of some Federal
under the Perkins Loan Program, all deferments are
Consolidation Loans.
followed by a post-deferment grace period of 6 months,
The United States, for the purpose of this deferment,
during which time you are not required to make payments.
includes any state of the Union, the District of Columbia, the
The Federal Family Education Loan (FFEL) Program
Commonwealth of Puerto Rico, American Samoa, Guam, the
includes Federal Stafford Loans, Federal PLUS Loans, Federal
Virgin Islands, the Commonwealth of the Northern Mariana
Consolidation Loans, and Federal Supplemental Loans for
Islands, the Freely Associated States (the Republic of the
Students (SLS).
Marshall Islands, the Federated States of Micronesia, and the
The Federal Perkins Loan (Perkins Loan) Program
Republic of Palau), and U.S. military bases and embassy
includes Federal Perkins Loans, National Direct Student
compounds in foreign countries.
Loans (NDSL), and National Defense Student Loans (Defense
The William D. Ford Federal Direct Loan (Direct Loan)
Loans).
Program includes Federal Direct Stafford/Ford (Direct
Full-time employment is defined as working at least 30
Subsidized) Loans, Federal Direct Unsubsidized Stafford/
hours per week in a position expected to last at least 3
Ford (Direct Unsubsidized) Loans, Federal Direct PLUS
consecutive months.
(Direct PLUS) Loans, and Federal Direct Consolidation
(Direct Consolidation) Loans.
Table 1. Capitalization Chart
Treatment of Interest with
Capitalized
Outstanding
Monthly
Number of
Loan Amt.
Total Repaid
Deferment/Forbearance
Interest
Principal
Payment
Payments
Interest is paid
$30,000
$0
$30,000
$333
120
$41,767
Interest is capitalized at the
$30,000
$1,800
$31,800
$353
120
$42,365
end
Interest is capitalized
$30,000
$1,841
$31,841
$354
120
$42,420
quarterly and at the end
SECTION 6: WHERE TO SEND THE COMPLETED DEFERMENT REQUEST
Return the completed form and any documentation to:
If you need help completing this form, call:
(If no address is shown, return to your loan holder.)
(If no phone number is shown, call your loan holder.)
Page 3 of 4
SECTION 7: IMPORTANT NOTICES
Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C.
To assist program administrators with tracking refunds
552a) requires that the following notice be provided to you:
and cancellations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to
The authorities for collecting the requested information
federal or state agencies. To provide a standardized method
from and about you are §421 et seq., §451 et seq., or §461 of
for educational institutions to efficiently submit student
the Higher Education Act of 1965, as amended (20 U.S.C.
enrollment statuses, disclosures may be made to guaranty
1071 et seq., 20 U.S.C. 1087a et seq., or 20 U.S.C. 1087aa et
agencies or to financial and educational institutions. To
seq.) and the authorities for collecting and using your Social
counsel you in repayment efforts, disclosures may be made
Security Number (SSN) are §§428B(f) and 484(a)(4) of the
to guaranty agencies, to financial and educational
HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31 U.S.C.
institutions, or to federal, state, or local agencies.
7701(b). Participating in the William D. Ford Federal Direct
Loan (Direct Loan) Program, Federal Family Education Loan
In the event of litigation, we may send records to the
(FFEL) Program, or Federal Perkins Loan (Perkins Loan)
Department of Justice, a court, adjudicative body, counsel,
Program and giving us your SSN are voluntary, but you must
party, or witness if the disclosure is relevant and necessary
provide the requested information, including your SSN, to
to the litigation. If this information, either alone or with
participate.
other information, indicates a potential violation of law, we
may send it to the appropriate authority for action. We may
The principal purposes for collecting the information on
send information to members of Congress if you ask them
this form, including your SSN, are to verify your identity, to
to help you with federal student aid questions. In
determine your eligibility to receive a loan or a benefit on a
circumstances involving employment complaints,
loan (such as a deferment, forbearance, discharge, or
grievances, or disciplinary actions, we may disclose relevant
forgiveness) under the Direct Loan, FFEL, or Federal Perkins
records to adjudicate or investigate the issues. If provided
Loan Programs, to permit the servicing of your loans, and, if
for by a collective bargaining agreement, we may disclose
it becomes necessary, to locate you and to collect and
records to a labor organization recognized under 5 U.S.C.
report on your loans if your loans become delinquent or
Chapter 71. Disclosures may be made to our contractors for
default. We also use your SSN as an account identifier and to
the purpose of performing any programmatic function that
permit you to access your account information
requires disclosure of records. Before making any such
electronically.
disclosure, we will require the contractor to maintain Privacy
The information in your file may be disclosed, on a case-
Act safeguards. Disclosures may also be made to qualified
by-case basis or under a computer matching program, to
researchers under Privacy Act safeguards.
third parties as authorized under routine uses in the
Paperwork Reduction Notice. According to the
appropriate systems of records notices. The routine uses of
Paperwork Reduction Act of 1995, no persons are required
this information include, but are not limited to, its disclosure
to respond to a collection of information unless such
to federal, state, or local agencies, to private parties such as
collection displays a valid OMB control number. The valid
relatives, present and former employers, business and
OMB control number for this information collection is
personal associates, to consumer reporting agencies, to
1845-0011. Public reporting burden for this collection of
financial and educational institutions, and to guaranty
information is estimated to average 10 minutes per
agencies in order to verify your identity, to determine your
response, including time for reviewing instructions,
eligibility to receive a loan or a benefit on a loan, to permit
searching existing data sources, gathering and maintaining
the servicing or collection of your loans, to enforce the
the data needed, and completing and reviewing the
terms of the loans, to investigate possible fraud and to verify
collection of information. The obligation to respond to this
compliance with federal student financial aid program
collection is required to obtain a benefit in accordance with
regulations, or to locate you if you become delinquent in
34 CFR 674.35, 674.35, 674.36, 674.37, 682.210, or 685.204. If
your loan payments or if you default. To provide default rate
you have comments or concerns regarding the status of
calculations, disclosures may be made to guaranty agencies,
your individual submission of this form, please contact your
to financial and educational institutions, or to state
loan holder directly (see Section 6).
agencies. To provide financial aid history information,
disclosures may be made to educational institutions.
Page 4 of 4
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