"Request for Review"

Request for Review is a 2-page legal document that was released by the U.S. Department of Education and used nation-wide.

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REQUEST FOR REVIEW
NAME___________________________________________ SSN__________________________
CURRENT ADDRESS ____________________________________________________________
If you object to offset against your Federal and/or State tax refunds and other payments for the
student loan described in the Loan Statement or notice, you can use this form to request a review or
hearing. If you object ONLY because you believe you cannot afford to pay this debt, but you wish
to arrange payment terms, DO NOT USE THIS FORM. INSTEAD, write or call the Contact listed
on the Loan Statement.
IMPORTANT. You should request and review copies of the records evidencing your loan
before you complete this statement. See the Notice of Proposed Treasury Offset for
instructions on how to request these records.
______________________________________________________________________________
I. Check ONLY ONE of the following:
A.
I want a review of my objection based on this written statement and the records in my loan
file. COMPLETE PARTS II AND IV OF THIS FORM.
B.
I want an in-person hearing in the city shown on the Loan Statement to present my objection.
I understand that I must pay my own expenses to appear for this hearing. COMPLETE PARTS II,
III, AND IV OF THIS FORM. Provide a telephone number where you can be reached during the
day: __________________
C.
I want a hearing by telephone. COMPLETE PARTS II, III, AND IV OF THIS FORM.
Provide a telephone number where you can be reached during the day: ____________________
________________________________________________________________________________
II. Check the objections that apply. ENCLOSE the documents described here (if you do not enclose
documents, your objections will be reviewed, based on the information on this form and the records
in your loan file):
1.
I do not owe the full amount shown because I repaid some or all of this loan. ENCLOSE
copies of front and back of checks, and copies of money orders and receipts for payments made on
the loan.
2.
I am making payments on this loan as required under the repayment agreement I reached with
the holder of the loan. ENCLOSE copies of repayment agreement and front and back of payment
checks.
3.
I filed for bankruptcy and my case is still open. ENCLOSE copies of any court document
showing name of court and case number.
4.
This loan was discharged in bankruptcy. ENCLOSE copies of discharge order and the
schedule of debts filed with the court.
5.
I am totally and permanently disabled and I submitted a completed Discharge Application:
Total and Permanent Disability to the U. S. Department of Education’s Total and permanent
Disability Servicer on ________________________________.
REQUEST FOR REVIEW
NAME___________________________________________ SSN__________________________
CURRENT ADDRESS ____________________________________________________________
If you object to offset against your Federal and/or State tax refunds and other payments for the
student loan described in the Loan Statement or notice, you can use this form to request a review or
hearing. If you object ONLY because you believe you cannot afford to pay this debt, but you wish
to arrange payment terms, DO NOT USE THIS FORM. INSTEAD, write or call the Contact listed
on the Loan Statement.
IMPORTANT. You should request and review copies of the records evidencing your loan
before you complete this statement. See the Notice of Proposed Treasury Offset for
instructions on how to request these records.
______________________________________________________________________________
I. Check ONLY ONE of the following:
A.
I want a review of my objection based on this written statement and the records in my loan
file. COMPLETE PARTS II AND IV OF THIS FORM.
B.
I want an in-person hearing in the city shown on the Loan Statement to present my objection.
I understand that I must pay my own expenses to appear for this hearing. COMPLETE PARTS II,
III, AND IV OF THIS FORM. Provide a telephone number where you can be reached during the
day: __________________
C.
I want a hearing by telephone. COMPLETE PARTS II, III, AND IV OF THIS FORM.
Provide a telephone number where you can be reached during the day: ____________________
________________________________________________________________________________
II. Check the objections that apply. ENCLOSE the documents described here (if you do not enclose
documents, your objections will be reviewed, based on the information on this form and the records
in your loan file):
1.
I do not owe the full amount shown because I repaid some or all of this loan. ENCLOSE
copies of front and back of checks, and copies of money orders and receipts for payments made on
the loan.
2.
I am making payments on this loan as required under the repayment agreement I reached with
the holder of the loan. ENCLOSE copies of repayment agreement and front and back of payment
checks.
3.
I filed for bankruptcy and my case is still open. ENCLOSE copies of any court document
showing name of court and case number.
4.
This loan was discharged in bankruptcy. ENCLOSE copies of discharge order and the
schedule of debts filed with the court.
5.
I am totally and permanently disabled and I submitted a completed Discharge Application:
Total and Permanent Disability to the U. S. Department of Education’s Total and permanent
Disability Servicer on ________________________________.
6.
This is not my Social Security Number, and I do not owe this loan. ENCLOSE copies of
your Driver's License or other identification issued by a government agency and your Social
Security Card.
7.
I believe that this loan is not an enforceable debt in the amount stated for the reasons explained
in the attached letter. [Attach a letter explaining any reason (for example, the loan was obtained by
another person through the crime of theft of your identity, or any other reason not listed above) for
your objection to collection of this loan amount by offset of your Federal and/or State tax refunds
and other payments. Be as specific as possible. ENCLOSE any records that support your reasons.]
8.
I used this loan to enroll in
(school) on or about / / , and I withdrew
from school on or about / / . I believe that I am owed, but have not been paid, a refund from the
school of $____________ . ENCLOSE any records you have showing your withdrawal.
9.
I used this guaranteed student loan to enroll in
(school) on or about
/ / ,
and I was unable to complete my education because the school closed.
10.
I had no high school diploma or GED when I enrolled at
(school)
with this guaranteed student loan. The school improperly determined my ability to benefit from the
training offered.
11.
When I borrowed this guaranteed student loan to attend
(school), I had a
condition (physical, mental, age, criminal record) that prevented me from meeting State
requirements for performing the occupation for which it trained me.
12.
I believe that
(school) without my permission signed my name on the loan
application, promissory note, loan check or electronic funds transfer (EFT) authorization.
[If you check 5, 8, 9, 10, 11, or 12, you will be asked to provide additional information in order to
avoid offset; parent borrowers should answer 8 - 12 about the student.]
______________________________________________________________________________
III. IF YOU WANT AN IN-PERSON OR TELEPHONE HEARING, YOU MUST
COMPLETE THE FOLLOWING:
The loan records and documents I submitted to support my statement in Part II do not show all the
material (important) facts about my objection to collection of this loan. I need a hearing to explain
the following important facts about this loan: (EXPLAIN the additional facts that you believe make
a hearing necessary on a separate sheet of paper. If you have already fully described these facts in
your response in Part II, WRITE HERE the number of the objection in which you described these
facts
.)
Note: If you do not receive an in-person or telephone hearing, your objection will be reviewed,
based on information and documents you supply with this form and on records in your loan file.
______________________________________________________________________________
IV. I state under penalty of law that the statements I have made here are true and accurate to the best
of my knowledge.
Date:______________________
Signature:___________________________________________
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