Federal Direct Consolidation Loan

OMB No. 1845-0053

Instructions for Application and Promissory Note Form Approved
Exp. Date 02/28/2014

Before You Begin Items 18-21: Enter the requested information for all of your education loans that you do not want to
Gather all of your education loan records, account statements, and bills so that you will have all the consolidate or that are not eligible for consolidation, but that you want considered when we
information needed to complete the Federal Direct Consolidation Loan Application and Promissory determine the maximum repayment period for your Direct Consolidation Loan.
Note (Note). Item 18: Follow the instructions for Item 13.
Print using a blue or black ballpoint pen. Enter dates as month-day-year (mm-dd-yyyy). Use only Item 19: Follow the instructions for Item 14.
numbers. Example: June 24, 1982 = 06-24-1982. Item 20: Follow the instructions for Item 15.
Some of the items in Sections A and C may have been completed for you. If so, review these items Item 21: Enter the current balance for each loan. Use the amount on your last statement or give
carefully to make sure the information is correct. Cross out any information that is incorrect and enter us an approximate amount.
the correct information. Put your initials next to any information that you change.
Section D: Repayment Plan Selection
Incorrect or incomplete information may delay processing.
See the instructions provided in this section.
Section A: Borrower Information
Section E: Borrower Understandings, Certifications, and Authorizations
Item 1. Enter your last name, then your first name and middle initial.
Items 22-24: Carefully read these items.
Item 2: Enter your nine-digit Social Security Number.
Section F: Promissory Note
Item 3: Enter your permanent address (number, street, apartment number, or rural route number
and box number, then city, state, and zip code). If your mailing address is a post office box or This is a legally binding contract.
general delivery, you must list both your permanent address and your mailing address. If you do not Item 25: Carefully read the Promise to Pay and the entire Note, including the Borrower
have a permanent street address or rural route number and box number, provide the physical Understandings, Certifications, and Authorizations in Section E, the terms and conditions on page 4,
location of your residence. and the Borrower’s Rights and Responsibilities Statement on pages 5-8.
Item 4: Enter the area code and telephone number at which you can most easily be reached. (Do Item 26: Sign and date the Note. If you do not sign the Note, your application cannot be processed.
not list your work telephone number here.) If you do not have a telephone, enter N/A.
Final Notes
Item 5 (optional): Enter your preferred e-mail address for receiving communications. You are not
required to provide this information. If you do, we may use your e-mail address to communicate with Review all the information on your Note. When complete, make a copy for your records and mail the
you. If you do not have an e-mail address or do not wish to provide one, enter N/A. original pages 1, 2, and 3 to us in the envelope provided, along with the completed Repayment Plan
Selection form and any required additional forms or documentation. If you no longer have the
Item 6: Enter any former names (such as a maiden name) under which one or more or your loans envelope, mail the Note to the address shown below.
may have been made. If none, enter N/A.
As soon as we receive your completed Note and supporting documents, we will begin processing
Item 7: Enter your date of birth. (unless you have entered your expected grace period end date in Section C1, Item 17). During this
Item 8: Enter the two-letter abbreviation for the state that issued your driver’s license, followed by time, we might call you with questions.
your driver’s license number. If you do not have a driver’s license, enter N/A. In the meantime, if you currently are required to make payments on your loans, continue to do so.
Item 9: Enter your employer’s name. If you are self-employed, enter the name of your business. If You will need to continue making payments until you receive written notification that your loans have
you are not employed, enter N/A. been successfully consolidated and it is time to start paying your Direct Consolidation Loan. If you
are having difficulty making payments on your loans, contact your loan holder or servicer at the
Item 10: Enter your employer’s address or, if you are self-employed, the address of your business correspondence address or telephone number on your current loan statements to find out ways you
(street, city, state, zip code). might be able to postpone loan payments; ask specifically about your “deferment” and “forbearance”
Item 11: Enter your work area code and telephone number. If you are self-employed, enter the area options.
code and telephone number of your business. IMPORTANT: We will send you a notice before we pay off your loans. This notice will (1) provide
Section B: Reference Information you with information about the loans and payoff amounts that we have verified with your loan
Item 12: Enter the requested information for two adults with different U.S. addresses who do not live holder(s) or through NSLDS, and (2) tell you the deadline by which you must notify us if you want to
with you and who have known you for at least three years. References who live outside the United cancel the Direct Consolidation Loan, or if you do not want to consolidate one or more of the loans
States are not acceptable. If a reference does not have a telephone number or e-mail address, or listed in the notice.
does not wish to provide an e-mail address, enter N/A. If you provide an e-mail address for a The notice that we send will include information about loans eligible for consolidation that you listed
reference, we may use it to communicate with the reference. in Section C1 (“Education Loan Indebtedness – Loans You Want to Consolidate”). It will also include
Section C1: Education Loan Indebtedness – Loans You Want to Consolidate information about additional loans eligible for consolidation that you did not list in Section C1, if you
have additional eligible loans with a holder of a loan that you listed in Section C1. For example, if
Section C2: Education Loan Indebtedness – Loans You Do Not Want to Consolidate
you have two Subsidized Federal Stafford Loans with Loan Holder A, but you listed only one of
Section C1 asks for information about your federal education loans that you want to consolidate. these loans in Section C1, the notice that we send will include information about both of your
Section C2 asks for information about your education loans that you are not consolidating, but want Subsidized Federal Stafford Loans that are with Loan Holder A. The notice will not include
to have considered when we determine your maximum repayment period. information about any loans that you listed in Section C2 (“Education Loan Indebtedness – Loans
You Do Not Want to Consolidate”) and those loans will not be consolidated.
If you need more space to list loans in Section C1 or C2, use the Additional Loan Listing Sheet
included with your Note. To find the information you will need to complete Sections C1 and C2, you If you do not inform us by the specified deadline that you do not want to consolidate one or
can look at the last monthly billing statement you received, your quarterly interest statement or more of the loans listed in the notice, all of the listed loans will be consolidated.
annual statement, your coupon book, or the Internet site of your loan holder or servicer. You may Loan Types and Their Codes (use these codes to complete Sections C1 and C2)
also obtain information about your loans by accessing the National Student Loan Data System
A Subsidized Federal Stafford Loans O Subsidized Federal Consolidation Loans
(NSLDS) at www.nslds.ed.gov.
B Guaranteed Student Loans (GSL) P Auxiliary Loans to Assist Students (ALAS)
Items 13-16: Enter the requested information for all of your federal education loans that you want to C Federal Insured Student Loans (FISL) Q Health Professions Student Loans (HPSL)
consolidate, including any Direct Loans that you want to consolidate. You must consolidate at
D Direct Subsidized Loans R Health Education Assistance Loans
least one Direct Loan or FFEL Program loan.
E Direct Subsidized Consolidation Loans (HEAL)
Item 13: Enter the code that corresponds to the loan type from the chart provided in these F Federal Perkins Loans S Federal PLUS Loans for
instructions (“Loan Types and Their Codes”). If you are not sure about the loan type, leave this Graduate/Professional Students
G Unsubsidized Federal Stafford Loans
item blank. T Federal PLUS Loans for Parents
(including Nonsubsidized Stafford Loans)
Item 14: Enter the full name and mailing address of the holder of the loan or the loan holder’s H Federal Supplemental Loans for Students U Direct PLUS Loans for Parents
servicer. (This is the address to which you are or will be sending your payments.) You must (SLS) V Direct PLUS Consolidation Loans
provide at least the name, city, and state of the loan holder or servicer. I Direct PLUS Loans for Y Nursing Student Loans (NSL)
Item 15: Enter the account number for each loan (the number should be on your statement or in Graduate/Professional Students Z Loans for Disadvantaged Students (LDS)
your payment book). If you cannot find the account number, leave this item blank. J Unsubsidized Federal Consolidation Loans
K Direct Unsubsidized Consolidation Loans W Education loans ineligible for consolidation
Item 16: Enter the estimated amount needed to pay off the loan, including any unpaid interest,
late fees, and collection costs. L Direct Unsubsidized Loans
Item 17: If you are in your grace period on any of the loans you wish to consolidate and you M National Direct Student Loans (NDSL)
want to delay processing of your Direct Consolidation Loan until you have completed your grace N National Defense Student Loans (NDSL)
period, enter the month and year of your expected grace period end date. If you provide this
information, processing of your Direct Consolidation Loan will be delayed until approximately 30-
60 days before the end of your grace period, and your consolidation loan will not enter
repayment until after your grace period ends. If you leave Item 17 blank, processing of your
consolidation loan will begin as soon as we receive your completed Note and any other required
documents, and any loans listed in Section C1 that are in a grace period will enter repayment
immediately upon consolidation. You will then lose the remaining portion of the grace period on
these loans.
 Federal Direct Consolidation Loan OMB No. 1845-0053
Form Approved
Application and Promissory Note Exp. Date 02/28/2014

WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or any accompanying
documentation is subject to penalties that may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097.

Before You Begin

Read the instructions for completing this Federal Direct Consolidation Loan Application and Promissory Note (Note). Print using blue or black ink or type. You
must sign and date this form. If you cross out anything and write in new information, put your initials beside the change.
NOTE: PAGES 1, 2 and 3 OF THIS NOTE MUST BE SUBMITTED FOR YOUR LOAN REQUEST TO BE PROCESSED.

Section A: Borrower Information

1. Last Name First Name Middle Initial 2. Social Security Number
TORRES IRMA 066800313

3. Permanent Address (if P.O. box or general delivery, see instructions) 4. Area Code/Telephone Number
(347) 4058085
PO Box 0600698 (929) 4446286

BROOKLYN NY 11206
City State Zip Code
5. E-Mail Address (Optional)
[email protected]
6. Former Name(s) 7. Date of Birth (mm-dd-yyyy) 8. Driver's License State and Number
09-07-1991 State Number

9. Employer's Name
N/A

10. Employer's Address

11. Work Area Code/Telephone Number City State Zip Code

Section B: Reference Information

12. References: List two persons with different U.S. addresses who do not live with you and who have known you for at least three years.

Name 1. franca pellot 2. salvador nazario jr

Permanent Address 1714 hart street 1st floor 1401 willoughby avenue apt 3c

City, State, Zip Code brooklyn, NY 11237 brooklyn, NY 11237

E-Mail Address
(optional)
Area Code/ Telephone
Number (917) 3098984 (917) 4076861
Relationship to
Borrower aunt uncle

Section C1: Education Loan Indebtedness - Loans You Want to Consolidate (continued on page 2)
Read the instructions before completing this section. List each federal education loan that you want to consolidate, including any William D. Ford Federal
Direct Loan (Direct Loan) Program loans that you want to include in your Direct Consolidation Loan. If you need more space to list additional loans, use the
Additional Loan Listing Sheet included with this Note. List each loan separately. Please print. IN THIS SECTION, LIST ONLY LOANS THAT YOU WANT TO
CONSOLIDATE.
We will send you a notice before we consolidate your loans. This notice will (1) provide you with information about the loans and payoff amounts that we have
verified, and (2) tell you the deadline by which you must notify us if you want to cancel the Direct Consolidation Loan, or if you do not want to consolidate one
or more of the loans listed in the notice. The notice will include information about loans eligible for consolidation that you listed in this section. It will also include
information about additional loans eligible for consolidation that you did not list in this section, if you have additional eligible loans with a holder of a loan that you
listed in this section. See the instructions for more information about the notice we will send.

13. Loan Code 14. Loan Holder/Servicer Name, Address, and Area Code/Telephone Number 15. Loan Account Number 16. Estimated Payoff Amount
(See Instructions) (See Instructions)

DEPT OF ED/FEDLOAN SERVICING(PHEAA)

PO BOX 530210
ATLANTA, GA 303530210
D 066800313S12G09283001 $2,774.00
DEPT OF ED/FEDLOAN SERVICING(PHEAA)
PO BOX 530210
ATLANTA, GA 303530210
L 066800313U12G09283001 $1,740.00

Submit pages 1, 2, and 3

Page 1 of 9
Borrower's Name (please print) IRMA TORRES Social Security Number 066800313

Section C1: Education Loan Indebtedness - Loans You Want to Consolidate (continued from page 1)

13. Loan Code 14. Loan Holder/Servicer Name, Address, and Area Code/Telephone Number 15. Loan Account Number 16. Estimated Payoff Amount
(See Instructions) (See Instructions)

DEPT OF ED/FEDLOAN SERVICING(PHEAA)

PO BOX 530210
ATLANTA, GA 303530210
D 066800313S12G09283002 $396.00
DEPT OF ED/FEDLOAN SERVICING(PHEAA)
PO BOX 530210
ATLANTA, GA 303530210
L 066800313U12G09283002 $190.00

17. Grace Period End Date. If any of the loans you want to consolidate are in a grace period, you can have the processing of Expected Grace Period End
your Direct Consolidation Loan delayed until the end of your grace period by entering your expected grace period end date in
the space provided. If you leave this item blank, we will begin processing your Direct Consolidation Loan as soon as we receive Date (month/year):
this Note and any other required documents and any loans listed in Section C1 that are in a grace period will enter repayment
immediately upon consolidation. You will then lose the remaining portion of the grace period on these loans.
Section C2: Education Loan Indebtedness - Loans You Do Not Want to Consolidate

Read the instructions before completing this section. List all education loans that you are not consolidating, but want to have considered when your
maximum repayment period is calculated. Remember to include any Direct Loan Program loans that you do not want to consolidate. If you need more space
to list additional loans, use the Additional Loan Listing Sheet included with this Note. List each loan separately. Please print. IN THIS SECTION, LIST ONLY
LOANS THAT YOU DO NOT WANT TO CONSOLIDATE.
We will send you a notice before we consolidate your loans. This notice will (1) provide you with information about the loans and payoff amounts that we have
verified, and (2) tell you the deadline by which you must notify us if you want to cancel the Direct Consolidation Loan, or if you do not want to consolidate one or
more of the loans listed in the notice. The notice will not include information about any loans you listed in this section, and any loans listed in this section will not
be consolidated. See the instructions for more information about the notice we will send.

18. Loan Code 19. Loan Holder/Servicer Name, Address, and Area Code/Telephone Number 20. Loan Account Number 21. Current Balance
(See Instructions) (See Instructions)

Section D: Repayment Plan Selection

To understand your repayment plan options, carefully read the repayment plan information in the Borrower's Rights and Responsibilities Statement on pages 5-8
of this Note and in any supplemental materials you receive with this Note. Then select a repayment plan for your Direct Consolidation Loan by completing the
Repayment Plan Selection form that accompanies this Note.
If you select the Income Contingent Repayment (ICR) Plan or the Income-Based Repayment (IBR) Plan, you must also complete additional forms and/or
provide additional documentation as explained on the Repayment Plan Selection form. Your selection of the ICR Plan or IBR Plan cannot be processed
without the required additional forms or documentation.
You must select the ICR Plan or the IBR Plan for repayment of your Direct Consolidation Loan if (1) you want to consolidate a defaulted loan(s) and you have
not made a satisfactory repayment arrangement with your current loan holder(s); or (2) you are consolidating a delinquent Federal Consolidation Loan that
the lender has submitted to the guaranty agency for default aversion, and you are not consolidating any additional eligible loans.

Submit pages 1, 2, and 3

Page 2 of 9
Borrower's Name (please print) IRMA TORRES Social Security Number 066800313
Section E: Borrower Understandings, Certifications, and Authorizations
22. I understand that:
A. My Direct Consolidation Loan will, to the extent used to pay off loans made under the Federal Family Education Loan (FFEL), Direct Loan, and Federal Perkins Loan (Perkins Loan) programs,
count against the applicable aggregate loan limits under the Act. The term "the Act" is defined under "Governing Law" on page 4 of this Note.
B. The amount of my Direct Consolidation Loan is the sum of the balances of my outstanding eligible loans that I have chosen to consolidate. My outstanding balance on each loan to be
consolidated includes unpaid principal, unpaid accrued interest and late charges as defined by federal regulations and as certified by the loan holder. Collection costs may also be included. For a
Direct Loan Program or FFEL Program loan that is in default, the amount of any collection costs that may be included in the payoff balances of the loans is limited to a maximum of 18.5% of the
outstanding principal and interest. For any other defaulted federal education loans, all collection costs that are owed may be included in the payoff balances of the loans.
C. Applying for a Direct Consolidation Loan does not obligate me to agree to take the Direct Consolidation Loan. The U.S. Department of Education (ED) will provide me with: (1) a notice containing
information about the loans and payoff amounts that ED has verified with the holders of my loans or through ED's National Student Loan Data System (NSLDS) before the actual payoffs occur;
and (2) the deadline by which I must notify ED if I want to cancel the Direct Consolidation Loan, or if I do not want to consolidate any of the loans that ED has verified. The notice that ED sends will
include information about loans eligible for consolidation that I listed in Section C1 of this Note ("Education Loan Indebtedness - Loans You Want to Consolidate"). It may also include information
about additional loans eligible for consolidation that I did not list in Section C1, if I have additional eligible loans with a holder of a loan listed in Section C1. If I do not inform ED otherwise by the
deadline specified in the notice that ED sends to me, all of the loans listed in the notice will be consolidated.
D. If the amount ED sends to my loan holders is more than the amount needed to pay off the balances of the selected loans, the holders will refund the excess amount to ED and this excess amount
will be applied against the outstanding balance of my Direct Consolidation Loan. If the amount that ED sends to my holders is less than the amount needed to pay off the balances of the loans
selected for consolidation, ED will include the remaining amount in my Direct Consolidation Loan.
E. Unless I am: (1) consolidating a delinquent Federal Consolidation Loan that the lender has submitted to the guaranty agency for default aversion; (2) consolidating a defaulted Federal
Consolidation Loan; (3) consolidating a Federal Consolidation Loan to use the Public Service Loan Forgiveness Program; or (4) consolidating a Federal Consolidation Loan to use the no accrual
of interest benefit for active duty service members, I may consolidate an existing Federal Consolidation Loan or Direct Consolidation Loan only if I include at least one additional eligible loan in the
consolidation.
F. If I am consolidating a delinquent Federal Consolidation Loan that the lender has submitted to the guaranty agency for default aversion or a defaulted Federal Consolidation loan, and I am not
including another eligible loan, I must agree to repay my Direct Consolidation Loan under the ICR Plan or the IBR Plan.
G. If I consolidate my loans, I may no longer be eligible for certain deferments, subsidized deferment periods, certain types of loan discharges or loan forgiveness, or reduced interest rates that were
available on the loans I am consolidating.
H. Any payments made prior to the date of consolidation on the loans I am consolidating will not count toward (1) the 25 years of repayment required for loan forgiveness under the IBR Plan or the
ICR Plan (see Item 10 of the Borrower's Rights and Responsibilities Statement in this Note), or (2) the 120 qualifying payments required for Public Service Loan Forgiveness (see Item 17 of the
Borrower's Rights and Responsibilities Statement).
I. If I am consolidating a Perkins Loan: (1) I will no longer be eligible for interest-free periods while I am enrolled in school at least half time, in the grace period on my loan, and during deferment
periods; and (2) I will no longer be eligible for full or partial loan cancellation under the Perkins Loan Program based on years of service in one of the following occupations: teacher in a low-
income elementary or secondary school; staff member in a eligible preschool program; special education teacher; member of the Armed Forces who qualifies for special pay; Peace Corps
volunteer or volunteer under the Domestic Volunteer Service Act of 1973; law enforcement or corrections officer; attorney in an eligible defender organization; teacher of mathematics, science,
foreign languages, bilingual education or any other high-need field; nurse or medical technician providing health care services; employee of a public or private nonprofit child or family service
agency that services high-risk children from low-income families and their families; fire fighter; faculty member at a Tribal College or University; librarian; or speech language pathologist.
J. If I am consolidating a Direct PLUS Loan or a Federal PLUS Loan that I obtained to help pay for my dependent child's undergraduate education, I will not be eligible to repay my Direct
Consolidation Loan under the IBR Plan. However, I may repay my Direct Consolidation Loan under the ICR Plan.
K. If I am consolidating any Direct Loan Program loans on which I received an up-front interest rebate, and I have not yet made the first 12 required on-time payments on those loans at the time
the loans are consolidated, I must make the first 12 required monthly payments on my Direct Consolidation Loan on time to keep the interest rebate (see Item 9 of the Borrower's Rights and
Responsibilities Statement).
23. Under penalty of perjury, I certify that:
A. The information that I have provided on this Note is true, complete, and correct to the best of my knowledge and belief and is made in good faith.
B. All of the loans selected for consolidation have been used to finance my education or the education of my dependent child(ren).
C. All of the loans selected for consolidation are in a grace period or in repayment ("in repayment" includes loans in deferment or forbearance).
D. If I owe an overpayment on a Federal Perkins Loan, Federal Pell Grant, Federal Supplemental Educational Opportunity Grant, Academic Competitiveness Grant (ACG), National Science and
Mathematics Access to Retain Talent (SMART) Grant, or Leveraging Educational Assistance Partnership Grant, I have made satisfactory arrangements with the holder to repay the amount owed.
E. If I am in default on any loan I am consolidating (except as provided above in Item 22.F.), I have either made a satisfactory repayment arrangement with the holder of that defaulted loan, or I will
repay my Direct Consolidation Loan under the ICR Plan or the IBR Plan.
F. If I have been convicted of, or pled nolo contendere or guilty to, a crime involving fraud in obtaining federal student aid funds under the Act, I have completed the repayment of those funds to ED,
or to the loan holder in the case of a Title IV federal student loan.
24. I make the following authorizations:
A. I authorize ED to contact the holders of the loans selected for consolidation to determine the eligibility for consolidation and the payoff amounts of the loans listed in Section C1 of this Note
and any of my other federal education loans that are held by a holder of a loan listed in Section C1. I further authorize release to ED or its agent of any information required to consolidate my
education loans in accordance with the Act.
B. I authorize ED to issue the proceeds of my Direct Consolidation Loan to the holders of the selected loans to pay off the debts.
C. I authorize ED to investigate my credit record and report information about my loan status to persons and organizations permitted by law to receive that information.
D. I authorize my school(s) and ED to release information about my Direct Consolidation Loan to the references on the loan and to members of my immediate family, unless I submit written directions
otherwise.
E. I authorize my school(s), ED, or their agents to verify my Social Security Number with the Social Security Administration (SSA) and, if the number on my loan record is incorrect, then I authorize
SSA to disclose my correct Social Security Number to these parties.
F. I authorize my schools, ED, and their respective agents and contractors to contact me regarding my loan request or my loan, including repayment of my loan, at the current or any future number
that I provide for my cellular telephone or other wireless device using automated dialing equipment or artificial or prerecorded voice or text messages.
Section F: Promissory Note (continued on page 6) - to be completed and signed by the borrower.
25. Promise to Pay. I promise to pay to the ED all sums disbursed under the terms of this Note to pay off my prior loan obligations, plus interest and other charges and fees that may become due as
provided in this Note. Unless I make interest payments, interest that accrues on my loan during forbearance periods and on the unsubsidized portion of my loan during deferment periods may be added,
as provided under the Act, to the principal balance of my loan. If I do not make payments on this Note when due, I will also pay reasonable collection costs, including but not limited to attorney's fees,
court costs, and other fees.
If ED accepts my application, I understand that ED will send funds to the holders of the loans that I want to consolidate to pay off those loans. I further understand that the amount of my Direct
Consolidation Loan will equal the sum of the payoff balances on the loans selected for consolidation. My signature on this Note serves as my authorization to pay off the balances of the loans selected
for consolidation as provided by the holders of the loans.
The payoff amount may be greater than or less than the estimated total balance I have indicated in Section C1. Further, I understand that if any collection costs are owed on the loans selected for
consolidation, these costs may be added to the principal balance of my Direct Consolidation Loan.
I will not sign this Note before reading the entire Note, even if I am told not to read it. I am entitled to an exact copy of this Note and the Borrower's Rights and Responsibilities Statement. My signature
certifies that I have read, understand, and agree to the terms and conditions of this Note, including the Borrower Understandings, Certifications, and Authorizations in Section E, and the Borrower's
Rights and Responsibilities Statement.
I UNDERSTAND THAT THIS IS A LOAN THAT I MUST REPAY.

26. Borrower's Signature IRMA TORRES Today's Date (mm-dd-yyyy) 05-07-2015

Submit pages 1, 2, and 3

Page 3 of 9
Promissory Note – continued from page 3

Governing Law a repayment plan. If I do not select a repayment plan, ED will choose a plan for
me in accordance with the Act.
The terms of this Federal Direct Consolidation Loan Application and Promissory
Note (Note) will be interpreted in accordance with the Higher Education Act of ED will provide me with a repayment schedule that identifies my payment
1965, as amended (20 U.S.C. 1070 et seq.), the U.S. Department of Education’s amounts and due dates. My first payment will be due within 60 days of the first
(ED’s) regulations, as they may be amended in accordance with their effective disbursement of my Direct Consolidation Loan unless it is in a deferment or
date, and other applicable federal laws and regulations (collectively referred to as forbearance period. If I am unable to make my scheduled loan payments, ED may
the “Act”). Applicable state law, except as preempted by federal law, may provide allow me to temporarily stop making payments, reduce my payment amount, or
for certain borrower rights, remedies, and defenses in addition to those stated in extend the time for making payments, as long as I intend to repay my loan.
this Note. Allowing me to temporarily delay or reduce loan payments is called forbearance.

Disclosure of Loan Terms ED may adjust payment dates on my Direct Consolidation Loan or may grant me
forbearance to eliminate a delinquency that remains even though I am making
This Note applies to a Federal Direct Consolidation Loan (Direct Consolidation scheduled installment payments.
Loan). Under this Note, the principal amount that I owe and am required to repay
will be equal to all sums disbursed to pay off my prior loan obligations, plus any I may prepay any part of the unpaid balance on my loan at any time without
unpaid interest that is capitalized and added to the principal amount. penalty. After I have repaid my Direct Consolidation Loan in full, ED will send me
a notice telling me that I have paid off my loan.
My Direct Consolidation Loan may have up to two separate loan identification
numbers depending on the loans I choose to consolidate. These loan Acceleration and Default
identification numbers will represent prior subsidized loans and prior unsubsidized
At ED’s option, the entire unpaid balance of the Direct Consolidation Loan will
loans. Each applicable loan identification number is represented by this Note. become immediately due and payable (this is called “acceleration”) if either of the
When the loans that I am consolidating are paid off, a disclosure statement will be following events occurs: (1) I make a false representation that results in my
provided to me. The disclosure will identify the amount of my Direct Consolidation receiving a loan for which I am not eligible; or (2) I default on the loan.
Loan, the associated loan identification number(s), and additional terms of the
The following events will constitute a default on my loan: (1) I fail to pay the entire
loan, such as the interest rate and repayment schedule. If I have questions about unpaid balance of the loan after ED has exercised its option under the preceding
the information disclosed, I may contact my servicer. Important additional
paragraph; (2) I fail to make installment payments when due, provided my failure
information is also contained in the Borrower’s Rights and Responsibilities has persisted for at least 270 days; or (3) I fail to comply with other terms of the
Statement. The Borrower’s Rights and Responsibilities Statement and any
loan, and ED reasonably concludes that I no longer intend to honor my
disclosure I receive in connection with the loan made under this Note are hereby repayment obligation. If I default, ED may capitalize all outstanding interest. This
incorporated into this Note. will increase the principal balance, and the full amount of the loan, including the
I understand that ED may use a servicer to handle billing and other new principal balance and collection costs, will become immediately due and
communications related to my loan. payable.

Interest If I default, the default will be reported to national consumer reporting agencies
and will significantly and adversely affect my credit rating. I understand that a
Interest will be calculated using a formula provided for by the Act. Unless ED default will have additional adverse consequences to me as disclosed in the
notifies me in writing of a lower rate, the interest rate on my Direct Consolidation Borrower’s Rights and Responsibilities Statement. Following default, I may be
Loan will be based on the weighted average of the interest rates on the loans required to repay the loan (including potential collection of amounts in excess of
being consolidated, rounded to the nearest higher one-eighth of one percent, but the principal and interest) under the Income Contingent Repayment (ICR) Plan or
will not exceed 8.25%. This is a fixed interest rate, which means that the rate will the IBR Plan in accordance with the Act.
remain the same throughout the life of the loan.
Legal Notices
I agree to pay interest on the principal amount of my Direct Consolidation Loan
from the date of disbursement until the loan is paid in full or discharged, except Any notice required to be given to me will be effective if sent by first class mail to
for interest ED does not charge me during a deferment period on the subsidized the most recent address that ED has for me, by electronic means to an address I
portion of my Direct Consolidation Loan. ED may add interest that accrues but is have provided, or by any other method of notification permitted or required by
not paid when due to the unpaid principal balance of this loan, as provided under applicable statute or regulation. I will immediately notify ED of a change of contact
the Act. This is called capitalization. information or status, as specified in the Borrower’s Rights and Responsibilities
Statement.
Late Charges and Collection Costs
If ED fails to enforce or insist on compliance with any term on this Note, this does
ED may collect from me: (1) a late charge of not more than six cents for each not waive any right of ED. No provision of this Note may be modified or waived
dollar of each late payment if I fail to make any part of a required installment except in writing by ED. If any provision of this Note is determined to be
payment within 30 days after it becomes due, and (2) any other charges and fees unenforceable, the remaining provisions will remain in force.
that are permitted by the Act related to the collection of my Direct Consolidation
Loan. If I default on my loan, I will pay reasonable collection costs, plus court Information about my loan will be submitted to the National Student Loan Data
costs and attorney fees. System (NSLDS). Information in NSLDS is accessible to schools, lenders, and
guarantors for specific purposes as authorized by ED.
Repayment
I must repay the full amount of the Direct Consolidation Loan made under this
Note, plus accrued interest. I will repay my loan in monthly installments during a
repayment period that begins on the date of the first disbursement of the loan,
unless it is in a deferment or forbearance period. Payments made by me or on my
behalf will be applied first to late charges and collection costs that are due, then
to interest that has not been paid, and finally to the principal amount of the loan,
except during periods of repayment under the Income-Based Repayment (IBR)
Plan. Under the IBR Plan, payments will be applied first to interest that is due,
then to fees that are due, and then to the principal amount.
ED will provide me with a choice of repayment plans. Information on these plans
is included in the Borrower’s Rights and Responsibilities Statement. I must select

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Borrower’s Rights and Responsibilities Statement

Important Notice: This Borrower’s Rights and Responsibilities Statement 4. Adding eligible loans to your Direct Consolidation Loan. You may add
provides additional information about the terms and conditions of the loan you will eligible loans to your Direct Consolidation Loan by submitting a request to us
receive under the accompanying Federal Direct Consolidation Loan (Direct within 180 days of the date your Direct Consolidation Loan is made. (Your Direct
Consolidation Loan) Application and Promissory Note (Note). Please keep a Consolidation Loan is “made” on the date we pay off the first loan that you are
copy of the Note and this Borrower’s Rights and Responsibilities Statement consolidating.) After we pay off any loans that you add during the 180-day period,
for your records. we will notify you of the new total amount of your Direct Consolidation Loan and
In this document, the words “we,” “us,” and “our” refer to the U.S. Department of of any adjustments that must be made to your monthly payment amount and/or
Education. interest rate.
1. The William D. Ford Federal Direct Loan Program. The William D. Ford If you want to consolidate any additional eligible loan(s) after the 180-day period,
Federal Direct Loan (Direct Loan) Program includes the following types of loans, you must apply for a new Direct Consolidation Loan.
known collectively as “Direct Loans”: 5. Loans that may be consolidated. General. Only the federal education loans
• Federal Direct Stafford/Ford Loans (Direct Subsidized Loans) listed in Items 3a.and 3b. of this Borrower’s Rights and Responsibilities
Statement may be consolidated into a Direct Consolidation Loan. You may only
• Federal Direct Unsubsidized Stafford/Ford Loans (Direct Unsubsidized Loans)
consolidate loans that are in a grace period or in repayment (including loans in
• Federal Direct PLUS Loans (Direct PLUS Loans)
deferment or forbearance). At least one of the loans that you consolidate must be
• Federal Direct Consolidation Loans (Direct Consolidation Loans) a Direct Loan Program loan or a Federal Family Education Loan (FFEL) Program
The Direct Loan Program is authorized by Title IV, Part D, of the Higher loan.
Education Act of 1965, as amended, 20 U.S.C. 1070 et seq. (HEA). Defaulted loans. You may consolidate a loan that is in default if (a) you first make
Direct Loans are made by the U.S. Department of Education. We contract with satisfactory repayment arrangements with the holder of the defaulted loan, or (b)
servicers to service, answer questions about, and process payments on Direct you agree to repay your Direct Consolidation Loan under the Income Contingent
Loans. We will provide you with the address and telephone number of the Repayment (ICR) Plan or the Income-Based Repayment (IBR) Plan (see Item
servicer for your loan. 10).
2. Laws that apply to this Note. The terms and conditions of loans made under Existing consolidation loans. Generally, you may consolidate an existing Direct
this Note are determined by the HEA and other applicable federal laws and Consolidation Loan or Federal Consolidation Loan into a new Direct
regulations. These laws and regulations are referred to as “the Act” throughout Consolidation Loan only if you include at least one additional eligible loan in the
this Borrower’s Rights and Responsibilities Statement. State law, unless it is consolidation. However, you may consolidate a Federal Consolidation Loan into a
preempted by federal law, may provide you with certain rights, remedies, and new Direct Consolidation Loan without including an additional loan if the Federal
defenses in addition to those stated in the Note and this Borrower’s Rights and Consolidation Loan is delinquent and has been submitted by the lender to the
Responsibilities Statement. guaranty agency for default aversion, or if the Federal Consolidation Loan is in
NOTE: Any change to the Act applies to loans in accordance with the default. In such cases, you must agree to repay the new Direct Consolidation
effective date of the change. Loan under the ICR Plan or the IBR Plan. You may also consolidate a single
Federal Consolidation Loan into a new Direct Consolidation Loan to use the
3. Direct Consolidation Loan identification numbers. Depending on the Public Service Loan Forgiveness program described in Item 17 of this Borrower’s
type(s) of federal education loan(s) that you choose to consolidate, your Direct
Rights and Responsibilities Statement, or the no accrual of interest benefit for
Consolidation Loan may have up to two individual loan identification numbers. active duty service members described in Item 8.
However, you will have only one Direct Consolidation Loan and will receive only
one bill. 6. Information you must report to us. Until your loan is repaid, you must notify
your servicer if you:
3a. The subsidized portion of your Direct Consolidation Loan (“Direct Subsidized
Consolidation Loan”) will have one loan identification number representing the • Change your address or telephone number;
amount of the following types of loans that you consolidate: • Change your name (for example, maiden name to married name);
• Change your employer or your employer’s address or telephone number
• Subsidized Federal Stafford Loans
changes; or
• Direct Subsidized Loans
• Have any other change in status that would affect your loan (for example, if
• Subsidized Federal Consolidation Loans
you receive a deferment while you are unemployed, but you find a job and
• Direct Subsidized Consolidation Loans therefore no longer meet the eligibility requirements for the deferment)
• Federal Insured Student Loans (FISL)
• Guaranteed Student Loans (GSL) 7. Interest rate. The interest rate on your Direct Consolidation Loan will be the
lesser of the weighted average of the interest rates on the loans being
3b. The unsubsidized portion of your Direct Consolidation Loan (“Direct consolidated, rounded to the nearest higher one-eighth of one percent, OR
Unsubsidized Consolidation Loan”) will have one identification number 8.25%. We will send you a notice that tells you the interest rate on your loan.
representing the amount of the following types of loans that you consolidate:
The interest rate on a Direct Consolidation Loan is a fixed rate. This means that
• Unsubsidized and Nonsubsidized Federal Stafford Loans the interest rate will remain the same throughout the life of your loan.
• Direct Unsubsidized Loans
If you qualify under the Servicemembers Civil Relief Act, the interest rate on your
• Unsubsidized Federal Consolidation Loans
loans obtained prior to military service may be limited to 6% during your military
• Direct Unsubsidized Consolidation Loans service. To receive this benefit, you must contact your servicer for information
• Federal PLUS Loans (for parents or for graduate and professional students) about the documentation you must provide to show that you qualify.
• Direct PLUS Loans (for parents or for graduate and professional students)
• Direct PLUS Consolidation Loans 8. Payment of interest. Except as provided below for borrowers who serve in the
military, interest accrues on a Direct Consolidation Loan from the date the loan is
• Federal Perkins Loans
made until it is paid in full or discharged, including during periods of deferment or
• National Direct Student Loans (NDSL)
forbearance. You are responsible for paying all interest that accrues, except for
• National Defense Student Loans (NDSL) interest that accrues on the subsidized portion of a Direct Consolidation Loan
• Federal Supplemental Loans for Students (SLS) (“Direct Subsidized Consolidation Loan” – see Item 3a.) during deferment
• Parent Loans for Undergraduate Students (PLUS) periods.
• Auxiliary Loans to Assist Students (ALAS)
If you do not pay the interest as it accrues during the periods described above,
• Health Professions Student Loans (HPSL)
we will add the interest to the unpaid principal amount of your loan at the end of
• Health Education Assistance Loans (HEAL) the deferment or forbearance period. This is called “capitalization.” Capitalization
• Nursing Student Loans (NSL) increases the unpaid principal balance of your loan, and interest will then accrue
• Loans for Disadvantaged Students (LDS) on the increased principal amount.

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The chart below shows the difference in the total amount you would repay on a your loan will tell you if you received a rebate), you will have to make the first 12
$15,000 Direct Unsubsidized Consolidation Loan if you pay the interest as it required monthly payments on your Direct Consolidation Loan on time to keep the
accrues during a 12-month deferment or forbearance period, compared to the interest rebate. “On time” means that we must receive each payment no later
amount you would repay if you do not pay the interest and it is capitalized. than 6 days after the due date. You will lose the rebate if you do not make all of
If you pay the If you do not your first 12 required monthly payments on your Direct Consolidation Loan on
interest as it pay the interest time. If you lose the rebate, we will add the rebate amount back to the principal
accrues… and it is balance on your loan account. This will increase the amount that you must repay.
capitalized… 10. Repaying your loan. Unless you receive a deferment or forbearance on your
loan (see Item 16), your first payment will be due within 60 days of the first
Loan Amount $15,000 $15,000 disbursement of your Direct Consolidation Loan. Your servicer will notify you of
the date your first payment is due.
Capitalized $0 $1,238
Interest for 12 You must make payments on your loan even if you do not receive a bill or
Months (at the repayment notice.
maximum rate Generally, you must repay all of your Direct Loans under the same repayment
of 8.25%) plan. You may choose one of the following repayment plans to repay any Direct
Consolidation Loan:
Principal to be $15,000 $16,238
Repaid • Standard Repayment Plan – Under this plan, you will make fixed monthly
payments and repay your loan in full within 10 to 30 years (not including
Monthly $146 $158 periods of deferment or forbearance) from the date the loan entered
Payment repayment, depending on the amount of your Direct Consolidation Loan and
(Standard the amount of your other student loan debt (not to exceed the amount you are
Repayment consolidating) as listed in Section C2 of your Note (see the chart below). Your
Plan) payments must be at least $50 a month ($600 a year) and will be more, if
necessary, to repay the loan within the required time period.
Number of 180 180
Payments • Graduated Repayment Plan – Under this plan, your payments will be lower
at first and will then increase over time, usually every two years. You will
Total Amount $26,209 $28,359 repay your loan in full within 10 to 30 years (not including periods of deferment
Repaid or forbearance) from the date the loan entered repayment, depending on the
total amount of your Direct Consolidation Loan and the amount of your other
In this example, you would pay $12 less per month and $2,150 less altogether if student loan debt (not to exceed the amount you are consolidating) as listed in
you pay the interest as it accrues during a 12-month deferment or forbearance Section C2 of your Note (see the chart below). No single payment under this
period. plan will be more than three times greater than any other payment.
You may be able to claim a federal income tax deduction for interest payments Maximum Repayment Periods Under the Standard and Graduated
you make on Direct Loans. For further information, refer to IRS Publication 970, Repayment Plans
which is available at http://www.irs.ustreas.gov. Total Education Loan Maximum Repayment Period
Under the no interest accrual benefit for active duty service members, during Indebtedness
periods of qualifying active duty military service interest does not accrue on the
Less than $7,500 10 years
portion of a Direct Consolidation Loan that repaid a Direct Loan Program or FFEL
Program loan first disbursed on or after October 1, 2008 (for up to 60 months). $7,500 to $9,999 12 years
9. Repayment incentive programs. A repayment incentive is a benefit that we $10,000 to $19,999 15 years
offer to encourage you to repay your loan on time. Under a repayment incentive $20,000 to $39,999 20 years
program, the interest rate we charge on your loan may be reduced. Some
repayment incentive programs require you to make a certain number of payments $40,000 to $59,999 25 years
on time to keep the reduced interest rate. For Direct Consolidation Loans, the $60,000 or more 30 years
following repayment incentive program may be available to you:
Interest Rate Reduction for Automatic Withdrawal of Payments
• Extended Repayment Plan – You may choose this plan only if: (1) you had
Under the automatic withdrawal option, your bank automatically deducts your no outstanding balance on a Direct Loan Program loan as of October 7, 1998,
monthly loan payment from your checking or savings account and sends it to us. or on the date you obtained a Direct Loan Program loan on or after October 7,
Automatic withdrawal helps to ensure that your payments are made on time. In 1998; and (2) you have an outstanding balance on Direct Loan Program Loans
addition, you receive a 0.25% interest rate reduction while you repay under the that exceeds $30,000. Under this plan, you may choose to make either fixed
automatic withdrawal option. We will include information about the automatic or graduated monthly payments and will repay your loan in full over a
withdrawal option in your first bill. You can also get this information on your repayment period not to exceed 25 years (not including periods of deferment
servicer’s web site, or by calling your servicer. Your servicer’s web site address or forbearance) from the date your loan entered repayment. If you choose to
and toll-free telephone number are provided on all correspondence that your make fixed monthly payments, your payments must be at least $50 a month
servicer sends you. ($600 a year) and will be more, if necessary, to repay the loan within the
Your servicer can provide you with more information on other repayment required time period. If you choose to make graduated monthly payments,
incentive programs that may be available. your payments will start out lower and will then increase over time, generally
every two years. Under a graduated repayment schedule, your monthly
Note: Another repayment incentive program, the up-front interest rebate, is
payment must at least be equal to the amount of interest that accrues each
available on Direct Subsidized Loans, Direct Unsubsidized Loans, and Direct
month, and no single payment will be more than three times greater than any
PLUS Loans that were first disbursed before July 1, 2012. The rebate is equal to
other payment.
a percentage of the loan amount, and is the same amount that would result if the
interest rate on the loan were lowered by a specific percentage. To permanently • Income Contingent Repayment (ICR) Plan – Under this plan, your monthly
keep an up-front interest rebate, a borrower must make each of the first 12 payment amount will be based on your adjusted gross income (and that of
required monthly payments on time when the loan enters repayment. If you your spouse if you are married), your family size, and the total amount of your
consolidate a Direct Loan on which you received an up-front interest rebate Direct Loans. Until we obtain the information needed to calculate your monthly
before you permanently earn the rebate (the correspondence you received about payment amount, your payment will equal the amount of interest that accrues
monthly on your loan unless you request a forbearance. As your income

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 changes, your payments may change. If you do not repay your loan after 25 • We will report your default to national consumer reporting agencies (see Item
years under this plan, the unpaid portion will be forgiven. You may have to pay 15).
income tax on any amount forgiven. 15. Consumer reporting agency notification. We will report information about
In addition to the repayment plans listed above, you may also choose the your loan to each national consumer reporting agency on a regular basis. This
following repayment plan to repay a Direct Consolidation Loan if you are not information will include the disbursement dates, amount, and repayment status of
consolidating a parent Direct PLUS Loan or a parent Federal PLUS Loan (see your loan (for example, whether you are current or delinquent in making
Note below): payments). Your loan will be identified as an education loan.
• Income-Based Repayment (IBR) Plan – Under this plan, your required If you default on a loan, we will report the default to national consumer reporting
monthly payment amount will be based on your income. To initially qualify for agencies. We will notify you at least 30 days in advance that we plan to report
this plan and to continue to make income-based payments, you must have a default information to a consumer reporting agency unless you resume making
partial financial hardship. Your monthly payment amount may be adjusted payments on the loan within 30 days of the date of the notice. You will be given a
annually. The maximum repayment period under this plan may exceed 10 chance to ask for a review of the debt before we report it.
years. If your loan is not repaid in full after you have made the equivalent of 25 If a consumer reporting agency contacts us regarding objections you have raised
years of qualifying payments and at least 25 years have elapsed, you may about the accuracy or completeness of any information we have reported, we are
qualify for forgiveness of any outstanding balance on your loans. You may required to provide the consumer reporting agency with a prompt response.
have to pay income tax on any amount forgiven.
16. Deferment and forbearance (postponing payments). If you meet certain
NOTE: A parent PLUS loan is a PLUS loan that you obtained to help pay for your requirements, you may receive a deferment that allows you to temporarily stop
dependent child’s undergraduate education. Direct Consolidation Loans that making payments on your loan. If you cannot make your scheduled loan
repaid parent Direct PLUS Loans or parent Federal PLUS Loans may not be payments, but do not qualify for a deferment, we may give you a forbearance. A
repaid under the IBR Plan. However, such loans may be repaid under the ICR forbearance allows you to temporarily stop making payments on your loan,
Plan. temporarily make smaller payments, or extend the time for making payments.
If you can show to our satisfaction that the terms and conditions of these Deferment
repayment plans are not adequate to meet your exceptional circumstances, we
may provide you with an alternative repayment plan. You may receive a deferment:
If you do not choose a repayment plan, we will choose a plan for you in • While you are enrolled at least half time at an eligible school;
accordance with the Act. • While you are in a full-time course of study in a graduate fellowship program;
• While you are in an approved full-time rehabilitation program for individuals
You may change repayment plans at any time after you have begun repaying
with disabilities;
your loan. There is no penalty if you make loan payments before they are due, or
• While you are unemployed (for a maximum of three years; you must be
pay more than the amount due each month.
diligently seeking, but unable to find, full-time employment); or
Except for payments made under the IBR Plan, we apply your payments in the • While you are experiencing an economic hardship (including Peace Corps
following order: (1) late charges and collection costs, (2) outstanding interest, and service), as determined under the Act (for a maximum of three years).
(3) outstanding principal. For payments made under the IBR Plan, we apply your • While you are serving on active duty during a war or other military operation or
payments in the following order: (1) outstanding interest, (2) late charges and national emergency, or performing qualifying National Guard duty during a war
collection costs, and (3) outstanding principal. or other military operation or national emergency, and if you were serving on
When you have repaid your loan in full, your servicer will send you a notice telling or after October 1, 2007, for an additional 180-day period following the
you that you have paid off your loan. You should keep this notice in a safe place. demobilization date for your qualifying service; or
11. Transfer of loan. We may transfer one or all of your loans to another servicer • If you are a member of the National Guard or other reserve component of the
without your consent. If the address to which you must send payments or U.S. Armed Forces (current or retired) and you are called or ordered to active
correspondence changes, you will be notified of the new servicer’s name, duty while enrolled at an eligible school, or within 6 months of having been
address and telephone number, the effective date of the transfer, and the date enrolled at least half time, you are eligible for a deferment during the 13
when you must begin sending payments or directing communications to that months following the conclusion of the active duty service, or until you return
servicer. Transfer of a loan to a different servicer does not affect your rights and to enrolled student status on at least a half-time basis, whichever is earlier.
responsibilities under that loan. You may be eligible to receive additional deferments if, at the time you received
12. Late charges and collection costs. If you do not make any part of a your first Direct Loan, you had an outstanding balance on a loan made under the
payment within 30 days after it is due, we may require you to pay a late charge. Federal Family Education Loan (FFEL) Program before July 1, 1993. If you meet
This charge will not be more than six cents for each dollar of each late payment. If this requirement, contact your servicer about additional deferments that may be
you do not make payments as scheduled, we may also require you to pay other available.
charges and fees involved in collecting your loan. You may receive a deferment while you are enrolled in school on at least a half-
13. Demand for immediate repayment. The entire unpaid amount of your loan time basis if: (1) you submit a deferment request form to your servicer along with
becomes due and payable (this is called “acceleration”) if you: documentation of your eligibility for the deferment; or (2) your servicer receives
information from the school you are attending that indicates you are enrolled at
• Make a false statement that causes you to receive a loan that you are not least half time. If your servicer processes a deferment based on information
eligible to receive; or received from your school, you will be notified of the deferment and will have the
• Default on your loan. option of canceling the deferment and continuing to make payments on your loan.
14. Defaulting on your loan. Default (failing to repay your loan) is defined in For all other deferments, you (or, for a deferment based on active military duty or
detail under “Acceleration and Default” on page 4 of this Note. If you default: qualifying National Guard duty during a war or other military operation or national
• You will be required to immediately repay the entire unpaid amount of your emergency, your representative) must submit a deferment request form to your
loan. servicer, along with documentation of your eligibility for the deferment. In certain
• We may sue you, take all or part of your federal tax refund or other federal circumstances, you may not be required to provide documentation of your
payments, and/or garnish your wages so that your employer is required to eligibility if your servicer confirms that you have been granted the same
send us part of your wages to pay off your loan. deferment for the same period of time on a FFEL Program loan. Your servicer
• You will be required to pay reasonable collection fees and costs, plus court can provide you with a deferment request form that explains the requirements for
costs and attorney fees. the type of deferment you are requesting. You may also obtain deferment request
• You will lose eligibility for other federal student aid and assistance under most forms and information on deferment eligibility requirements from your servicer’s
federal benefit programs. web site.
• You will lose eligibility for loan deferments. If you are in default on your loan, you are not eligible for a deferment.

Page 7 of 9
You are responsible for paying the interest that accrues on a Direct Unsubsidized • Your eligibility for one or more of the Direct Loan Program or FFEL Program
Consolidation Loan during a deferment period. You are not responsible for paying loans that you consolidated was falsely certified as a result of a crime of
the interest that accrues on a Direct Subsidized Consolidation Loan during a identity theft; or
deferment period. • The school did not pay a required refund of one or more Direct Loan Program
Forbearance or FFEL Program loans that you consolidated.
We may give you a forbearance if you are temporarily unable to make your We may forgive a portion of your Direct Consolidation Loan that repaid Direct
scheduled loan payments for reasons including, but not limited to, financial Subsidized or Direct Unsubsidized Loans you received after October 1, 1998, or
hardship and illness. subsidized or unsubsidized Federal Stafford Loans you received under the FFEL
program after October 1, 1998 if you: (1) teach full time for five consecutive years
We will give you a forbearance if:
in certain elementary and/or secondary schools or educational service agencies
• You are serving in a medical or dental internship or residency program, and that serve low-income families; (2) meet certain other qualifications; and (3) did
you meet specific requirements; not owe a Direct Loan or a FFEL Program loan as of October 1, 1998, or as of the
• The total amount you owe each month for all of the student loans you received date you obtain a loan after October 1, 1998.
under Title IV of the Act is 20% or more of your total monthly gross income (for A Public Service Loan Forgiveness program is available that provides for the
a maximum of three years); cancellation of the remaining balance due on your eligible Direct Loan Program
• You are serving in a national service position for which you receive a national loans after you have made 120 full, on-time, scheduled monthly payments (after
service education award under the National and Community Service Act of October 1, 2007) on those loans under certain repayment plans while you are
1990 (AmeriCorps). In some cases, the interest that accrues on a qualified employed full-time by certain public service organizations.
loan during the service period will be paid by the Corporation for National and
Community Service; The Act may provide for certain loan forgiveness or repayment benefits on your
loans in addition to the benefits described above. If other forgiveness or
• You qualify for partial repayment of your loans under the Student Loan
repayment options become available, your servicer will provide information about
Repayment Program, as administered by the Department of Defense;
these benefits.
• You are performing service that would qualify you for loan forgiveness under
the teacher loan forgiveness program that is available to certain Direct Loan To request a loan discharge based on one of the conditions described above
and FFEL program borrowers; or (except for discharges due to death or bankruptcy), you must complete an
• You are a member of the National Guard who qualifies for a post-active duty application that you may obtain from your servicer.
student deferment but not for a military service deferment or other deferment, In some cases, you may assert, as a defense against collection of your loan, that
and you are engaged in active state duty for a period of more than 30 the school did something wrong or failed to do something that it should have
consecutive days. done. You can make such a defense against repayment only if the school’s act or
To request a forbearance, contact your servicer. Your servicer can provide you omission directly relates to your loan or to the educational services that the loan
with a forbearance request form that explains the requirements for the type of was intended to pay for, and if what the school did or did not do would give rise to
forbearance you are requesting. You may also obtain forbearance request forms a legal cause of action against the school under applicable state law. If you
and information on forbearance eligibility requirements from your servicer’s web believe that you have a defense against repayment of your loan, contact your
site. Under certain circumstances, we may also give you a forbearance without servicer.
requiring you to submit a request or documentation. These circumstances We do not guarantee the quality of the academic programs provided by schools
include, but are not limited to, the following: that participate in federal student financial aid programs. You must repay your
• Periods necessary for us to determine your eligibility for a loan discharge; loan even if you do not complete your education, are unable to obtain
• A period of up to 60 days for us to collect and process documentation related employment in your field of study, or are dissatisfied with, or do not receive, the
to your request for a deferment, forbearance, change in repayment plan, or education you paid for with the loan.
consolidation loan (we do not capitalize interest charged during this period); or 18. Department of Defense and other federal agency loan repayment. Under
• Periods when you are involved in a military mobilization or are affected by a certain circumstances, military personnel may have education loans repaid by the
local or national emergency. Secretary of Defense. This benefit is offered as part of a recruitment program that
You are responsible for paying the interest that accrues on your entire Direct does not apply to individuals based on their previous military service or to those
Consolidation Loan during a forbearance period. who are not eligible for enlistment in the U.S. Armed Forces. For more
information, contact your local military service recruitment office.
17. Discharge (having your loan forgiven). We will discharge (forgive) your
Direct Consolidation Loan if: Other agencies of the federal government may also offer student loan repayment
programs as an incentive to recruit and retain employees. Contact the agency’s
• Your servicer receives acceptable documentation of your death. We will also human resources department for more information.
discharge the portion of a Direct Consolidation Loan that repaid one or more
Direct PLUS Loans or Federal PLUS Loans obtained on behalf of a student
who dies. END OF BORROWER’S RIGHTS AND RESPONSIBILITIES STATEMENT
• Your loan is discharged in bankruptcy. However, federal student loans are not
automatically discharged if you file for bankruptcy. To have your loan
discharged in bankruptcy, you must prove to the bankruptcy court in an
adversary proceeding that repaying the loan would cause undue hardship.
• You become totally and permanently disabled (as defined in the Act) and meet
certain other requirements.
In certain cases, we may also discharge all or a portion of your Direct
Consolidation Loan if:
• One or more Direct Loan Program, FFEL Program, or Federal Perkins Loan
Program loans that you consolidated was used to pay for a program of study
that you (or the dependent student for whom you borrowed a PLUS loan) were
unable to complete because the school closed;
• Your eligibility (or the eligibility of the dependent student for whom you
borrowed a PLUS loan) for one or more of the Direct Loan Program or FFEL
Program loans that you consolidated was falsely certified by the school;

Page 8 of 9
IMPORTANT NOTICES 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
Gramm-Leach-Bliley Act Notice 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
In 1999, Congress enacted the Gramm-Leach-Bliley Act (Public Law 106-102). that requires disclosure of records. Before making any such disclosure, we will
This Act requires that lenders provide certain information to their customers require the contractor to maintain Privacy Act safeguards. Disclosures may also
regarding the collection and use of nonpublic personal information. be made to qualified researchers under Privacy Act safeguards.
We disclose nonpublic personal information to third parties only as necessary to
process and service your loan and as permitted by the Privacy Act of 1974. See Financial Privacy Act Notice
the Privacy Act Notice below. We do not sell or otherwise make available any
information about you to any third parties for marketing purposes. Under the Right to Financial Privacy Act of 1978 (12 U.S.C. 3401-3421), ED will
have access to financial records in your student loan file maintained in
We protect the security and confidentiality of nonpublic personal information by compliance with the administration of the Direct Loan Program.
implementing the following policies and practices. All physical access to the sites
where nonpublic personal information is maintained is controlled and monitored
by security personnel. Our computer systems offer a high degree of resistance to Paperwork Reduction Notice
tampering and circumvention. These systems limit data access to our staff and According to the Paperwork Reduction Act of 1995, no persons are required to
contract staff on a “need-to-know” basis, and control individual users’ ability to respond to a collection of information unless the collection displays a valid OMB
access and alter records within the systems. All users of these systems are given control number. Public reporting burden for this collection of information is
a unique user ID with personal identifiers. All interactions by individual users with estimated to average 1.0 hour (60 minutes) per response, including time for
the systems are recorded. reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. The
Privacy Act Notice obligation to respond to this collection is required to obtain a benefit in
accordance with 34 CFR 685.201(c)(1). Send comments regarding the burden
The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice be
estimate or any other aspect of this collection of information, including
provided to you:
suggestions for reducing this burden, to the U.S. Department of Education, 400
The authority for collecting the requested information from and about you is §451 Maryland Ave., SW, Washington, DC 20210-4537 or e-mail
et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1087a [email protected] and reference OMB Control Number 1845-0053. Note:
et seq.) and the authorities for collecting and using your Social Security Number Please do not return the completed Federal Direct Consolidation Loan
(SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and 31 U.S.C. 7701(b). Application and Promissory Note to this address.
Participating in 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 Direct Loan Program, 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) become delinquent or in 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 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 status, 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

Page 9 of 9
 REPAYMENT PLAN REQUEST: OMB No. 1845-0014
Form Approved
Standard Repayment Plan/Extended Repayment Plan/Graduated Repayment Plan Exp. Date 12/31/2016
RPR William D. Ford Federal Direct Loan (Direct 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 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 | 0 | 6 | 6 | - | 8 | 0 | - | 0 | 3 | 1 | 3 |
Name IRMA TORRES
Address PO Box 0600698
City, State, Zip BROOKLYN, NY 11206
Telephone - Primary (347)4058085
Telephone - Alternate (929)4446286
E-mail (Optional) [email protected]

SECTION 2: REPAYMENT PLAN REQUEST

1. Choose one of the following:
I want to select a plan for all of my Direct Loans.
I want to select a plan for only my Direct Loans that are not eligible for the Income-Based Repayment
(IBR), Pay As You Earn, or Income-Contingent Repayment (ICR) Plan. The following loans are not eligible for
these plans:
Direct Parent PLUS Loans: not eligible for IBR, Pay As You Earn, or ICR.
Direct Consolidation Loans made on or after July 1, 2006 that repaid Direct Parent PLUS Loans or
Federal Parent PLUS Loans: not eligible for IBR or Pay As You Earn. These loans are eligible for ICR.
Direct Consolidation Loans made before July 1, 2006 that repaid Direct Parent PLUS Loans or Federal
Parent PLUS Loans (these are called "Direct PLUS Consolidation Loans"): not eligible for IBR, Pay As
You Earn, or ICR.
2. Check the box for the repayment plan that you wish to select:
These plans are described in Section 5. Sample payment amounts for each plan are provided in Section 7.
X Standard Graduated Extended - Fixed Payments Extended - Graduated Payments
Note:If you are interested in the IBR, Pay As You Earn, or ICR Plan, visit StudentLoans.gov to read or
complete the application or StudentAid.gov to learn more. To help you compare these plans to the
Standard, Graduated, and Extended plans, sample payment amounts for the IBR, Pay As You Earn,
and ICR Plans are provided in Section 7.

SECTION 3: BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION

I understand that: (1) I must choose the same repayment plan for all of my Direct Loans unless I want
to repay my loans under the IBR, Pay As You Earn, or ICR Plan and I have some loans that may not be
repaid under those plans. In this case, I may select the IBR, Pay As You Earn, or ICR plan for the loans
that are eligible for those plans by submitting the IBR/Pay As You Earn/ICR Plan Request, and may select
a different repayment plan for the loans that may not be repaid under IBR, Pay As You Earn, or ICR. (2) If I
am beginning repayment of my loans for the first time and I do not select a repayment plan, I will be placed
on the Standard Repayment Plan. (3) If I am delinquent in making payments under my current repayment
plan at the time I request to change to a different plan, my servicer may grant me a forbearance to cover any
payments that are overdue at the time I enter the repayment plan I selected in Section 2. Unpaid interest
that accrues during this forbearance period may be capitalized at the end of the forbearance period.
I certify that (1): The information I have provided on this form is true and correct and (2) I have read and
understand the terms and conditions of the repayment plan that I requested in Section 2, as explained in
Section 5.
I authorize the U.S. Department of Education (and its agents or contractors) to contact me regarding my
request 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.
Borrower Signature IRMA TORRES Date 05-07-2015
Page 1 of 5
SECTION 4: INSTRUCTIONS FOR COMPLETING THE FORM
Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Use only numbers. Example: January 31,
2013 = 01-31-2013. If you need help completing this form, contact your federal loan servicer. If you want to apply for a
repayment plan and your Direct Loans are serviced by different federal loan servicers, you must submit a separate
repayment plan request to each loan servicer.

Return the completed form and any required documentation to the address shown in Section 6.

SECTION 5: REPAYMENT PLAN DESCRIPTIONS

STANDARD REPAYMENT PLAN EXTENDED REPAYMENT PLAN
Under this plan, you will pay a fixed amount each  You may choose this plan only if (1) you had no
month over the course of your maximum repayment outstanding balance on a Direct Loan on
period in an amount that will ensure that your loan is October 7, 1998 or on the date you obtained a
fully repaid by the end of your repayment period. This Direct Loan after that date, and (2) you owe
plan may result in lower total interest paid when more than $30,000 in outstanding Direct Loans.
compared to other plans. For Direct Subsidized Loans,  Under this plan, you have the option of making
Direct Unsubsidized Loans, and Direct PLUS Loans, the either fixed or graduated payments over your
maximum repayment period is 10 years. For Direct maximum repayment period. Your payment
Consolidation Loans, the maximum repayment period amount will ensure that your loan is fully repaid
ranges from 10 to 30 years, depending on loan debt. by the end of your repayment period. If you
choose graduated payments, your payments
GRADUATED REPAYMENT PLAN start out low and then increase every two years.
Under this plan, your payments start out low and then  Under either the fixed or graduated monthly
increase every two years. No single payment under this payment option, the Extended Repayment Plan
plan will be more than three times greater than any will give you a lower monthly payment on your
other payment. Your payment amount will ensure that non-consolidation loans than the Standard or
your loan is fully repaid by the end of your repayment Graduated Repayment Plans. However,
period. Generally, the amount you will repay over the because of the longer repayment period, you
life of your loan will be higher under this plan than will pay more interest over the life of your
under the Standard Repayment Plan. This plan may be loans.
beneficial if your income is low now but is likely to  For all loan types, the maximum repayment
steadily increase. For Direct Subsidized Loans, Direct period is 25 years.
Unsubsidized Loans, and Direct PLUS Loans, the
maximum repayment period is 10 years. For Direct
Consolidation Loans, the maximum repayment period
ranges from 10 to 30 years, depending on loan debt.

See Section 7 for sample repayment amounts under each of these repayment plans.

SECTION 6: WHERE TO SEND THE COMPLETED REPAYMENT PLAN REQUEST

Return the completed form and any required If you need help completing this form, call:
documentation to: (If no telephone number is shown, call your loan
(If no address is shown, return to your loan servicer.) servicer.)

Page 2 of 5
SECTION 7: SAMPLE PAYMENT AMOUNTS
Below are two tables that provide examples of monthly and total payment amounts under the Standard, Graduated, and
Extended repayment plans. These figures are estimates, and use an interest rate of 8.25%. Various factors, including
your actual interest rate and the amount of your loan debt, may cause your payment amount to differ from the payment
amounts shown in these tables. Your federal loan servicer will provide you with the actual monthly payment amount
after you select a repayment plan.
Table 1. Sample Payment Amounts Under the Standard, Graduated, Extended-Fixed, and Extended-Graduated Plans
for Direct Subsidized, Unsubsidized, and PLUS Loans
Standard (10 years) Graduated (10 years) Extended-Fixed (25 years) Extended-Graduated (25 years)
Debt Minimum Maximum Minimum Maximum
Payment Total Paid Total Paid Payment Total Paid Total Paid
Payment Payment Payment Payment
$20,000 $245 $29,437 $144 $431 $32,177 Not Eligible - Not Eligible - -
$30,000 $368 $44,155 $216 $647 $48,265 Not Eligible - Not Eligible - -
$40,000 $491 $58,873 $287 $862 $64,353 $315 $94,614 $275 $417 $101,515
$50,000 $613 $73,592 $359 $1,078 $80,442 $394 $118,268 $344 $521 $126,899
$60,000 $736 $88,310 $431 $1,294 $96,530 $473 $141,921 $413 $625 $152,280
$70,000 $859 $103,028 $503 $1,509 $112,618 $552 $165,575 $481 $730 $177,664
$80,000 $981 $117,747 $575 $1,725 $128,706 $631 $189,228 $550 $834 $203,046
$90,000 $1,104 $132,465 $647 $1,940 $144,795 $710 $212,882 $619 $938 $228,427

Table 2. Sample Payment Amounts Under the Standard, Graduated, Extended-Fixed, and Extended-Graduated Plans
for Direct Consolidation Loans
Extended-Fixed (25
Standard (10-30 years) Graduated (10-30 years) Extended-Graduated (25 years)
yrs.)
Debt Maximum Maximum Minimu Maximu Maximu
Paymen Total Total Total Minimum Total
Repayme Repayme m m Payment m
t Paid Paid Paid Payment Paid
nt Period nt Period Payment Payment Payment
$20,00 Not Not
20 years $170 $40,899 20 years $138 $241 $44,420 - - -
0 Eligible Eligible
$30,00 Not Not
20 years $256 $61,349 20 years $206 $362 $66,631 - - -
0 Eligible Eligible
$40,00 $101,51 $101,51
25 years $315 $94,614 25 years $275 $417 $315 $94,614 $275 $417
0 5 5
$50,00 $118,26 $126,89 $118,26 $126,89
25 years $394 25 years $344 $521 $394 $344 $521
0 8 9 8 9
$60,00 $162,27 $166,14 $141,92 $152,28
30 years $451 30 years $413 $549 $473 $413 $625
0 4 5 1 0
$70,00 $189,31 $193,84 $165,57 $177,66
30 years $526 30 years $481 $640 $552 $481 $730
0 9 1 5 4
$80,00 $216,36 $221,53 $189,22 $203,04
30 years $601 30 years $550 $732 $631 $550 $834
0 5 1 8 6
$90,00 $243,41 $249,22 $212,88 $228,42
30 years $676 30 years $619 $823 $710 $619 $938
0 0 8 2 7

Page 3 of 5
SECTION 7: SAMPLE PAYMENT AMOUNTS (CONTINUED)
Below are three tables that provide examples of monthly and total payment amounts under the IBR, Pay As You Earn,
and ICR Plans. These figures are estimates, and use an interest rate of 8.25%. The figures also make an assumption that
you are single, do not have anyone else in your household, and that you live in one of the 48 contiguous states. Various
factors, including your actual interest rate, the amount of your loan debt, your income, and whether and how quickly it
rises (these figures assume income increases 5% per year), may cause your payment amount to differ from the payment
amounts shown in these tables. These figures use the 2013 Poverty Guidelines (published by the U.S. Department of
Health and Human Services) and Income Percentage Factors.
Table 3. Sample Payment Amounts for the Income-Based Repayment (IBR) Plan for Those Who Are Not New
Borrowers On/After July 1, 2014
Starting income of $25,000 Starting income of $40,000 Starting income of $60,000
Time Time Time
Debt Initial Final Total to Initial Final Total to Initial Final Total to
Payment Payment Paid Repay Payment Payment Paid Repay Payment Payment Paid Repay
(Mos.) (Mos.) (Mos.)
$20,000 $97 $245 $43,861 219 Not Eligible - - - Not Eligible - - -

$40,000 $97 $491 $89,628 300 $285 $491 $72,680 173 Not Eligible - - -

$60,000 $97 $642 $94,175 300 $285 $736 $148,999 268 $535 $736 $97,093 143
$80,000 $97 $642 $94,175 300 $285 $981 $193,464 300 $535 $981 $156,150 193
$100,000 $97 $642 $94,175 300 $285 $1,227 $201,322 300 $535 $1,227 $236,102 251

Table 4. Sample Payment Amounts for the Pay As You Earn Plan for Eligible Borrowers & IBR Plan for Those Who Are
New Borrowers On/After July 1, 2014
Starting income of $25,000 Starting income of $40,000 Starting income of $60,000
Debt Time to Time to Time to
Initial Final Total Initial Final Total Initial Final Total
Repay Repay Repay
Payment Payment Paid Payment Payment Paid Payment Payment Paid
(Mos.) (Mos.) (Mos.)
$20,000 $65 $245 $38,488 240 $190 $245 $31,254 134 Not Eligible - - -

$40,000 $65 $309 $40,127 240 $190 $491 $85,707 240 $356 $491 $64,729 143
$60,000 $65 $309 $40,127 240 $190 $625 $89,727 240 $356 $736 $129,366 222
$80,000 $65 $309 $40,127 240 $190 $625 $89,727 240 $356 $981 $154,976 240
$100,000 $65 $309 $40,127 240 $190 $625 $89,727 240 $356 $1,046 $155,860 240

Table 5. Sample Payment Amounts for the Income-Contingent Repayment (ICR) Plan
Starting income of $25,000 Starting income of $40,000 Starting income of $60,000
Debt Time to Time to Time to
Initial Final Total Initial Final Total Initial Final Total
Repay Repay Repay
Payment Payment Paid Payment Payment Paid Payment Payment Paid
(Mos.) (Mos.) (Mos.)
$20,000 $151 $199 $43,436 249 $193 $219 $33,513 161 $219 $251 $30,761 131
$40,000 $225 $423 $96,630 274 $385 $438 $67,027 161 $438 $502 $61,523 131
$60,000 $225 $694 $146,629 300 $475 $658 $106,605 175 $658 $754 $92,284 131
$80,000 $225 $1,018 $162,256 300 $475 $939 $176,175 233 $809 $1,015 $124,521 240
$100,000 $225 $1,018 $163,256 300 $475 $1,360 $281,310 298 $809 $1,296 171,619 158

Page 4 of 5
SECTION 8: IMPORTANT NOTICES
Privacy Act Notice. The Privacy Act of 1974 (5 USC 552a) educational institutions to efficiently submit student
requires that the following notice be provided to you: enrollment status, disclosures may be made to guaranty
The authority for collecting the requested information agencies or to financial and educational institutions. To
from and about you is §421 et seq., §451 et seq., and/or counsel you in repayment efforts, disclosures may be
§461 et seq. of the Higher Education Act (HEA) of 1965, as made to guaranty agencies, to financial and educational
amended (20 USC 1071 et seq., 20 USC 1087a et seq., institutions, or to federal, state, or local agencies.
and/or 20 USC 1087aa et seq.), and the authorities for In the event of litigation, we may send records to the
collecting and using your Social Security Number (SSN) are Department of Justice, a court, adjudicative body, counsel,
§484(a)(4) of the HEA (20 USC 1091(a)(4)) and 31 USC party, or witness if the disclosure is relevant and necessary
7701(b). Participating in the Federal Family Education to the litigation. If this information, either alone or with
Loan (FFEL) Program, William D. Ford Federal Direct Loan other information, indicates a potential violation of law,
(Direct Loan) Program, and Federal Perkins Loan (Perkins) we may send it to the appropriate authority for action. We
Program and giving us your SSN are voluntary, but you may send information to members of Congress if you ask
must provide the requested information, including your them to help you with federal student aid questions. In
SSN, to participate. circumstances involving employment complaints,
The principal purposes for collecting the information on grievances, or disciplinary actions, we may disclose
this form, including your SSN, are to verify your identity, relevant records to adjudicate or investigate the issues. If
to determine your eligibility to receive a loan or a benefit provided for by a collective bargaining agreement, we may
on a loan (such as a deferment, forbearance, discharge, or disclose records to a labor organization recognized under
forgiveness) under the FFEL Program, Direct Loan 5 USC Chapter 71. Disclosures may be made to our
Program, and/or Perkins Program, to permit the servicing contractors for the purpose of performing any
of your loan(s), and, if it becomes necessary, to locate you programmatic function that requires disclosure of records.
and to collect and report on your loan(s) if your loan(s) Before making any such disclosure, we will require the
become delinquent or in default. We also use your SSN as contractor to maintain Privacy Act safeguards. Disclosures
an account identifier and to permit you to access your may also be made to qualified researchers under Privacy
account information electronically. Act safeguards.
The information in your file may be disclosed, on a case- Paperwork Reduction Notice. According to the
by-case basis or under a computer matching program, to Paperwork Reduction Act of 1995, no persons are required
third parties as authorized under routine uses in the to respond to a collection of information unless it displays
appropriate systems of records notices. The routine uses a currently valid OMB control number. Public reporting
of this information include, but are not limited to, its burden for this collection of information is estimated to
disclosure to federal, state, or local agencies, to private average 0.167 hours (10 minutes) per response, including
parties such as relatives, present and former employers, the time for reviewing instructions, searching existing data
business and personal associates, to consumer reporting resources, gathering and maintaining the data needed,
agencies, to financial and educational institutions, and to and completing and reviewing the information collection.
guaranty agencies in order to verify your identity, to Individuals are obligated to respond to this collection to
determine your eligibility to receive a loan or a benefit on obtain a benefit in accordance with 34 CFR 685.208. Send
a loan, to permit the servicing or collection of your loan(s), comments regarding the burden estimate(s) or any other
to enforce the terms of the loan(s), to investigate possible aspect of this collection of information, including
fraud and to verify compliance with federal student suggestions for reducing this burden to the U.S.
financial aid program regulations, or to locate you if you Department of Education, 400 Maryland Avenue, SW,
become delinquent in your loan payments or if you Washington, DC 20210-4537 or e-mail
default. To provide default rate calculations, disclosures [email protected] and reference OMB Control
may be made to guaranty agencies, to financial and Number 1845-0014. Note: Please do not return the
educational institutions, or to state agencies. To provide completed form to this address.
financial aid history information, disclosures may be made If you have questions regarding the status of your
to educational institutions. To assist program individual submission of this form, contact your loan
administrators with tracking refunds and cancellations, servicer (see Section 6).
disclosures may be made to guaranty agencies, to financial
and educational institutions, or to federal or state
agencies. To provide a standardized method for
Page 5 of 5