Reaffirmation Form

OMB No. 1845-0133
Form Under Review
Expiration Date: XX/XX/XXXX

REAFFIRMATION AGREEMENT
William D. Ford Federal Direct Loan (Direct Loan) Program
Federal Family Education Loan (FFEL) Program

REA
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 the U.S. Criminal
Code and 20 U.S.C. 1097.

SECTION 1: BORROWER IDENTIFICATION
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 Address

(
(

)
)

-

SECTION 2: INFORMATION ABOUT ELIGIBILITY
You have lost eligibility for federal student financial aid because you inadvertently received a Direct Loan or FFEL program loan
that caused you to exceed the annual or aggregate loan limit (“overborrowing”), as shown below. To get complete information
about your loan(s), contact information regarding your loan holder(s), or if you don't know who your loan holder is, you can get
that information by logging in to StudentAid.gov.
To regain eligibility for federal student financial aid, you may either:
1. Repay the excess loan amount now, in which case you should contact your loan holder for instructions and not
complete this form: or
2. Agree to repay (reaffirm) the excess according to the terms and conditions of your promissory note, in which case you
should review the information in Section 3 and then sign and return this form to your loan holder.
NOTE: If the overborrowing was caused by more than one loan and the loans are held by different loan holders, a
separate form will need to be submitted to each loan holder.

SECTION 3: SCHOOL AND LOAN INFORMATION (TO BE COMPLETED BY THE SCHOOL)
NOTE: If NSLDS shows that a borrower consolidated the loan(s) that caused the inadvertent overborrowing into a Direct or FFEL
Consolidation Loan, no further action on the part of the borrower is needed. By signing the consolidation loan promissory note,
the borrower agreed to repay any excess loan amount.
Name of Institution

OPEID

Address

City, State, Zip Code

Name/Title of School Official
Loan Type

First Disb.
Date

Telephone
Disbursed
Amount

Excess
Amount

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Loan Holder/Servicer

Borrower Name:

Borrower SSN:

SECTION 4: REQUEST, UNDERSTANDINGS, PROMISE TO PAY, AND AUTHORIZATION
 I request that my loan holder send confirmation of my reaffirmation to the school identified in Section 3.
 I understand that
1. I will have reaffirmed the excess loan amount that I received only after I sign and return this form to my loan
holder and it is processed.
2. After I have reaffirmed the excess loan amount, my school will determine what types and amounts of federal
student financial aid I am eligible to receive.
3. Reaffirmation does not make me eligible to receive additional Direct Subsidized Loans or Direct Unsubsidized
Loans if I have no remaining eligibility under the applicable annual or total (aggregate) limit.
 I promise to pay the loan holder the excess loan amount shown in Section 3 under the terms of the promissory note
that I signed to receive the Direct Loan or FFEL program loan(s) identified in Section 3, plus interest and other charges
and fees that may become due as provided in my promissory note.
 I authorize my loan holder and its agents or contractors to contact me regarding my reaffirmation agreement or my
loan(s), including repayment of my loan(s), at the number that I provide on this form or any future number that I
provide for my cellular telephone or other wireless device using automated telephone dialing equipment or artificial or
prerecorded voice or text messages.

Date:

Borrower's Signature

SECTION 5: WHERE TO SEND THE COMPLETED AFFIRMATION AGREEMENT
Return the completed form to:
(if no address is shown, return to your loan holder.)

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

SECTION 6: 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 (both subsidized
and unsubsidized), Federal PLUS Loans, Federal
Consolidation Loans, and Federal Supplemental
Loans for Students (SLS).

handle billing and other communications related to
your loans. References to "your loan holder" on this
form mean either your loan holder or your loan
servicer.
 Federal student financial aid includes the Federal Pell
Grant Program, the Federal Supplemental Educational
Opportunity Grant Program, the Teacher Education
Assistance for College and Higher Education (TEACH)
Grant Program, the Federal Work-Study Program, the
William D. Ford Federal Direct Loan (Direct Loan)
Program, the Iraq and Afghanistan Service Grant, and
the Federal Perkins Loan Program.

 The holder of your Direct Loan Program loan(s) is
the U.S. Department of Education (the
Department). The holder of your FFEL Program
loan(s) may be a lender, a guaranty agency, or the
Department. Your loan holder may use a servicer to

 Inadvertent overborrowing is the exceeding of an
annual or aggregate loan limit without any evidence
that you exceeded the limit as a result of deliberate
action on your part or on the part of the school that
determined your eligibility for the loan.
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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. and §451
et seq. of the Higher Education Act of 1965, as amended
(20 U.S.C. 1071 et seq. and 20 U.S.C. 1087a et seq.), and
the authorities for collecting and using your Social Security
Number (SSN) are §§428B(f) and 484(a)(4) of the Higher
Education Act (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31
U.S.C. 7701(b). Participating in the Federal Family
Education Loan (FFEL) Program or the William D. Ford
Federal Direct Loan (Direct 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 FFEL and/or Direct
Loan Programs, to permit the servicing of your loan(s), and,
if it becomes necessary, to locate you and to collect and
report on your loan(s) if your loan(s) becomes delinquent
or defaults. 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 loan(s), to
enforce the terms of the loan(s), 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 it displays a valid
OMB control number. The valid OMB control number for this
collection is 1845-0133. Public reporting burden for this
collection of information is estimated to average 5 minutes
(0.08 hours) per response, including the time for reviewing
instructions, searching existing data resources, 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 668.34(d). If you have questions regarding the status of
your individual submission of this form, contact your loan
holder (see Section 5).

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