ECONOMIC HARDSHIP DEFERMENT REQUEST

Before answering any questions, carefully read the entire form, including the instructions and other information in Sections 4, 5, and 6. n I meet the qualifications stated in Section 6 for the Economic Hardship Deferment checked below and request that my loan holder defer repayment of my loan(s) beginning . To qualify, I must meet one of the conditions listed below and must provide the required documentation, as described in Section 6, for only that condition. (You must provide this date regardless of which condition you check below.) Check one: (1) r I have been granted an economic hardship deferment under the William D. Ford Federal Direct Loan (Direct Loan) Program or the Federal Perkins Loan Program for the same period of time for which I am requesting this deferment. I have attached documentation of the deferment . (2) r I am receiving or received payments under a federal or state public assistance program, such as Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), Food Stamps, or state general public assistance. I have attached documentation of these payments . (3) r I am serving as a Peace Corps volunteer. I have attached documentation certifying my period of service in the Peace Corps . (4) r I work full-time and my monthly income, as defined in Section 5, does not exceed the larger of (A) the Federal Minimum Wage Rate or (B) the Poverty Line income for a family of two for my state (regardless of my actual family size), as listed below. I have attached documentation of this income . My monthly income is $ ____________. (A) Federal Minimum Wage Rate (monthly amount, based on $5.15 an hour): $892.66 (B) Poverty Lines for a Family of Two (monthly amounts): $1,100.00 (48 contiguous states and the District of Columbia) $1,375.00 (Alaska) $1,265.00 (Hawaii) (5) r I do not work full-time and my monthly income, as defined in Section 5, does not exceed the larger of (A) two times the Federal Minimum Wage Rate, or (B) two times the Poverty Line income for a family of two for my state (regardless of my actual family size), as listed above under condition (4) . In addition, after deducting the total monthly payments that I am making on all of my federal education debts from my monthly income, the amount remaining does not exceed the larger of (A) the Federal Minimum Wage Rate or (B) the Poverty Line income for a family of two for my state, as listed above under condition (4) . If my repayment period is more than 10 years, my total monthly federal education debt payments will be adjusted to reflect a 10-year repayment period. If my repayment period is 10 years or less, my holder will use my actual scheduled monthly payment amount. I have attached documentation of my monthly income and my federal education loan debt . NOTE: A worksheet to help you determine whether you meet this condition is available from your loan holder. Completion of the worksheet is optional. Your loan holder will determine whether you qualify based on the income and education debt information that you provide below. My monthly income is $ ____________. For all of my federal education loans now in repayment (including loans for which I am requesting this deferment) I owe the following amounts: • For all of my loans that have a repayment period of 10 years or less, the total amount that I pay each month is $________. • For all of my loans that have a repayment period of more than 10 years, the total amount I owed when the loans entered repayment is $________. (6) r I work full-time, and the total amount of my monthly payments on all of my federal education loans in repayment is equal to or larger than 20% of my monthly income, as defined in Section 5. In addition, after deducting the total amount of my monthly payments on my federal education loans in repayment from my monthly income, the amount remaining is less than 220% of the larger of (A) the Federal Minimum Wage rate, or (B) the Poverty Line income for a family of two for my state (regardless of my actual family size), as listed above under condition (4) . If my repayment period is more than 10 years, my total monthly federal education loan payments will be adjusted, to reflect a 10-year repayment period. If my repayment period is 10 years or less, my holder will use my actual scheduled monthly payment amount. I have attached documentation of my monthly income and my federal education loan debt . NOTE: A worksheet to help you determine whether you meet this condition is available from your loan holder. Completion of the worksheet is optional. Your loan holder will determine whether you qualify based on the income and education debt information that you provide below. My monthly income is $ ____________. For all of my federal education loans now in repayment (including loans for which I am requesting this deferment) I owe the following amounts: • For all of my loans that have a repayment period of 10 years or less, the total amount that I pay each month is $_________. • For all of my loans that have a repayment period of more than 10 years, the total amount I owed when the loans entered repayment is $_________. n I understand that: (1) I am not required to make payments of loan principal during my deferment. Interest will not be charged on my subsidized loan(s) during my deferment. However, interest will be charged on my unsubsidized loan(s). (2) I have the option of making interest payments on my unsubsidized loan(s) during my deferment. (3) I may choose to make interest payments by checking the box below. My loan holder may capitalize interest that I do not pay during the deferment period. r I wish to make interest payments on my unsubsidized loan(s) during my deferment. n I certify that the information I provided in Sections 1 and 2 above is true and correct, and that I have read, understand, and meet the terms and conditions and eligibility criteria of the deferment for which I have applied, as explained in Section,download