1845-0011 HRD 2021 Economic Hardship Deferment Request

ECONOMIC HARDSHIP DEFERMENT REQUEST

0MB No. 1845-0011
Form Under Review
Exp. Date x/x/xxxx

William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family
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
HRD

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.

D Check this box if any of your information has changed.
SSN
Name

Address
State

City
Telephone-Primary

Zip Code -----

Telephone-Alternate
Email (Optional)
SECTION 2: BORROWER DETERMINATION OF DEFERMENT ELIGIBILITY
Maximum cumulative eligibility is 36 months per loan program. Instead of deferment, consider a repayment plan that
bases your monthly payment amount on your income. Visit StudentAid.gov/lDR for more information.

1. Have you received this type of deferment on a loan
made under another federal student loan program for
the same period of time that you want this deferment?
For example, check "yes" if you want this
deferment on your Direct Loans and you are on this
deferment on your FFEL Program loans.
D Yes-Attach documentation of the deferment.
Skip to Section 3.
D No-Continue to Item 2.

2. Have you received or are you receiving payments
under a federal or state public assistance program for
the same period of time that you want this deferment?
Qualifying programs include: Temporary
Assistance for Needy Families (TANF), Supplemental
Security Income (551), Supplemental Nutrition
Assistance Program (SNAP), state general public
assistance, or other means-tested benefits.
D Yes-Attach documentation of the payments.
Skip to Section 3.
D No-Continue to Item 3.
3. Are you serving as a Peace Corps volunteer?
D Yes-Attach documentation certifying your
period of service. Skip to Section 3.
D No-Continue to Item 4.
4. Do you work full time?
Full-time employment means working 30 or more
hours per week in a position expected to last at least 3
consecutive months.
D Yes-Continue to Item 5.
D No - You are not eligible for this deferment.

s.

What is your monthly income? -------You must attach documentation of your monthly
income. Monthly income is either (you choose):
• Your gross taxable income from all sources or
• One-twelfth of the Adjusted Gross Income from
your most recent federal income tax return.

6. What is your family size ?
Family size includes:
• You;
• Your spouse;
• Your children if they receive more than half of
their support from you, including unborn children
who will be born during the deferment period;
and
• Other people if, at the time you request this
deferment, they live with you, receive more than
half their support from you, and will continue to
receive this support from you during the
deferment period. Support includes money, gifts,
loans, housing, food, clothes, car, medical and
dental care, and payment of college costs.
7. Is the amount you reported in Item 5 less than 150%
of the poverty guideline for your family size and state
of residence (see Table 2 in Section 5)?
D Yes-Continue to Section 3.
D No-You are not eligible for this deferment.

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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 have an economic hardship, as described in Section 2.
• That my deferment begin on:

. D

-------

If checked, to make interest payments on my loans during my 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 or the date that I requested.
• My deferment will end on the earlier of the date that I exhaust my maximum eligibility, the certified deferment end
date, or when 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.
• Unless I am a Peace Corps volunteer, my deferment will be granted in increments of 1 year. If I continue to be eligible
for an Economic Hardship Deferment after 1 year, I may reapply, subject to the cumulative maximum.
• My loan holder may grant me a forbearance while processing my form or to cover any period of delinquency that
exists when I submit my form.
• Unpaid interest may capitalize on my loans during or at the expiration of my deferment or forbearance, but interest
never capitalizes on Perkins Loans.
I certify that:

• 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.

--------------------

Borrower's Signature

Date

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, 2019 = 03-14-2019. 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. If you have loans made jointly (as co-makers), both borrowers must individually meet the requirements for a
deferment and each of you must submit a separate deferment request. Return the completed form and any required
documentation to the address shown in Section 6.
SECTION 5: DEFINITIONS

The William D. Ford Federal Direct Loan (Direct
Loan) Program includes Federal Direct Stafford/Ford
(Direct Subsidized) Loans, Federal Direct Unsubsidized
Stafford/Ford (Direct Unsubsidized) Loans, Federal
Direct PLUS (Direct PLUS) Loans, and Federal Direct
Consolidation (Direct Consolidation) Loans.

The Federal Family Education Loan (FFEL) Program
includes Federal Stafford Loans, Federal PLUS Loans, Federal
Consolidation Loans, and Federal Supplemental Loans for
Students (SLS).
The Federal Perkins Loan (Perkins Loan) Program
includes Federal Perkins Loans, National Direct Student Loans
(NDSL), and National Defense Student Loans (Defense Loans).
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SECTION 5: DEFINITIONS (CONTINUED)

A forbearance is a period during which you are permitted
to postpone making payments temporarily, allowed an
extension of time for making payments, or temporarily
allowed to make smaller payments than scheduled.
The holder of your Direct Loans is the Department. The
holder of your FFEL Program loans may be a lender, guaranty
agency, secondary market, or the Department. The holder of
your Perkins Loans is an institution of higher education or the
Department. Your loan holder may use a servicer to handle
billing and other communications related to your loans.
References to "your loan holder" on this form mean either
your loan holder or your servicer.

Capitalization is the addition of unpaid interest to
the principal balance of your loan. Capitalization causes
more interest to accrue over the life of your loan and
may cause your monthly payment amount to increase.
Interest never capitalizes on Perkins Loans.
Table 1 (below) provides an example of the monthly
payments and the total amount repaid for a $30,000
unsubsidized loan. The example loan has a 6% interest
rate and the example deferment or forbearance lasts for
12 months and begins when the loan entered
repayment. The example compares the effects of paying
the interest as it accrues or allowing it to capitalize.
A co-maker is one of the two individuals who are
joint borrowers on a Direct or Federal Consolidation
Loan or a Federal PLUS Loan. Both co-makers are
responsible for repaying the full amount of the loan.
A deferment is a period during which you are
entitled to postpone repayment of your loans. Interest is
not generally charged to you during a deferment on
your subsidized loans. Interest is always charged to you
during a deferment on your unsubsidized loans. On
loans made under the Perkins Loan Program, all
deferments are followed by a post-deferment grace
period of 6 months, during which time you are not
required to make payments.

A subsidized loan is a Direct Subsidized Loan, a Direct
Subsidized Consolidation Loan, a Federal Subsidized Stafford
Loan, portions of some Federal Consolidation Loans, a Federal
Perkins Loan, an NDSL, and a Defense Loan.
An unsubsidized loan is a Direct Unsubsidized Loan, a
Direct Unsubsidized Consolidation Loan, a Direct PLUS Loan, a
Federal Unsubsidized Stafford Loan, a Federal PLUS Loan, a
Federal SLS, and portions of some Federal Consolidation
Loans.

Table 1. Capitalization Chart
Treatment of Interest with
Deferment/Forbearance

Loan
Amount

Capitalized
Interest

Outstanding
Principal

Monthly
Payment

Number of
Payments

Total
Repaid

Interest is paid

$30,000

$0

$30,000

$333

120

$41,767

Interest is capitalized at the
end
Interest is capitalized
quarterly and at the end

$30,000

$1,800

$31,800

$353

120

$42,365

$30,000

$1,841

$31,841

$354

120

$42,420

Table 2. 150% of the Poverty Guidelines for 2021 (Monthly)
Family Size

1
2
3
4
5
6
7
8
Each additional
person,add

Alaska

Hawaii

$2,011.25
$2,721.25
$3,431.25
$4,141.25
$4,851.25
$5,561.25
$6,271.25
$6,981.25
$710.00

$1,852.SC
$2,5O5.OC
$3,157.SC
$3,810.00
$4,465.50
$5,115.00
$5,767.50
$6,420.00
$652.50

All Others

$1,610.00
$2,177.50
$2,745.00
$3,312.50
$3,880.00
$4,447.50
$5,015.00
$5,582.50
$567.50

If you do not live in the United States, use the poverty guideline amount in
the column labeled "All Others".
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SECTION 6: WHERE TO SEND THE COMPLETED DEFERMENT REQUEST

If you need help completing this form, call:
(If no phone number is shown, call your loan holder.)

Return the completed form and any documentation to:
(If no address is shown, return to your loan holder.)

SECTION 7: IMPORTANT NOTICES
Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C. 552a)

requires that the following notice be provided to you:
The authorities for collecting the requested information
from and about you are §421 et seq., §451 et seq., or §461 et
seq. of the Higher Education Act of 1965, as amended (20
U.S.C. 1071 et seq., 20 U.S.C. 1087a et seq., or 20 U.S.C. 1087aa
et seq.) and the authorities for collecting and using your Social
Security Number (SSN) are §§428B(f) and 484(a)(4) of the HEA
(20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31 U.S.C. 7701(b).
Participating in the William D. Ford Federal Direct Loan (Direct
Loan) Program, Federal Family Education Loan (FFEL)
Program, or Federal Perkins Loan (Perkins Loan) Program and
giving us your SSN are voluntary, but you must provide the
requested information, including your SSN, to participate.
The principal purposes for collecting the information on
this form, including your SSN, are to verify your identity, to
determine your eligibility to receive a loan or a benefit on a
loan (such as a deferment, forbearance, discharge, or
forgiveness) under the Direct Loan, FFEL, or Federal Perkins
Loan Programs, to permit the servicing of your loans, and, if it
becomes necessary, to locate you and to collect and report on
your loans if your loans become delinquent or default. We also
use your SSN as an account identifier and to permit you to
access your account information electronically.
The information in your file may be disclosed, on a case­
by-case basis or under a computer matching program, to third
parties as authorized under routine uses in the appropriate
systems of records notices. The routine uses of this
information include, but are not limited to, its disclosure to
federal, state, or local agencies, to private parties such as
relatives, present and former employers, business and
personal associates, to consumer reporting agencies, to
financial and educational institutions, and to guaranty
agencies in order to verify your identity, to determine your
eligibility to receive a loan or a benefit on a loan, to permit the
servicing or collection of your loans, to enforce the terms of
the loans, to investigate possible fraud and to verify
compliance with federal student financial aid program
regulations, or to locate you if you become delinquent in your
loan payments or if you default. To provide default rate
calculations, disclosures may be made to guaranty agencies,
to financial and educational institutions, or to state agencies.
To provide financial aid history information, disclosures may
be made to educational institutions.

To assist program administrators with tracking refunds
and cancellations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to
federal or state agencies. To provide a standardized method
for educational institutions to efficiently submit student
enrollment statuses, disclosures may be made to guaranty
agencies or to financial and educational institutions. To
counsel you in repayment efforts, disclosures may be made
to guaranty agencies, to financial and educational
institutions, or to federal, state, or local agencies.
In the event of litigation, we may send records to the
Department of Justice, a court, adjudicative body, counsel,
party, or witness if the disclosure is relevant and necessary
to the litigation. If this information, either alone or with
other information, indicates a potential violation of law, we
may send it to the appropriate authority for action. We may
send information to members of Congress if you ask them
to help you with federal student aid questions. In
circumstances involving employment complaints,
grievances, or disciplinary actions, we may disclose relevant
records to adjudicate or investigate the issues. If provided
for by a collective bargaining agreement, we may disclose
records to a labor organization recognized under 5 U.S.C.
Chapter 71. Disclosures may be made to our contractors for
the purpose of performing any programmatic function that
requires disclosure of records. Before making any such
disclosure, we will require the contractor to maintain Privacy
Act safeguards. Disclosures may also be made to qualified
researchers under Privacy Act safeguards.
Paperwork Reduction Notice. According to the
Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless such
collection displays a valid 0MB control number. The valid
0MB control number for this information collection is
1845-0011. Public reporting burden for this collection of
information is estimated to average 10 minutes per
response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the
collection of information. The obligation to respond to this
collection is required to obtain a benefit in accordance with
34 CFR 674.34, 674.35, 674.36, 674.37, 682.210, or 685.204.
If you have comments or concerns regarding the
status of your individual submission of this form, please
contact your loan holder directly (see Section 6).

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