Economic Hardship Deferment Request
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4ECONOMIC HARDSHIP DEFERMENT REQUEST
OMB No. 1845-0011
Form Approved
William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family
Exp. Date 9/30/2018
Education Loan (FFEL) Program / Federal Perkins Loan (Perkins Loan) Program
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on
HRD
any accompanying document is subject to penalties that may include fines, imprisonment, or both, under
the U.S. Criminal Code and 20 U.S.C. 1097.
SECTION 1: BORROWER INFORMATION
Please enter or correct the following information.
Check this box if any of your information has changed.
SSN
Name
Address
City
State
Zip Code
Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: BORROWER DETERMINATION OF DEFERMENT ELIGIBILITY
Carefully read the entire form before completing it. Complete Section 2 in its entirety. Maximum cumulative
eligibility is 36 months per loan program. The federal student loan programs include the Direct Loan, FFEL, and Perkins
Loan programs. For FFEL Program borrowers only, you are only eligible if all of your FFEL Program loans were first disbursed
one or after July 1, 1993, or if you had no balance on a FFEL Program loan that was disbursed before July 1, 1993 when you
received a loan on or after July 1, 1993. Instead of deferment, consider a repayment plan that determines your monthly
StudentAid.gov/IDR
payment amount based on your income. Visit
for more information.
1. Have you been granted an Economic Hardship
3. Are you serving as a Peace Corps volunteer?
Deferment on a loan made under another federal
Yes - Attach documentation certifying your
student loan program for the same period of time
period of service. Skip to Section 3.
for which you are applying for this deferment?
No - Continue to Item 4.
For example, check "yes" if you are requesting
deferment on your Direct Loans because you are on
4. Do you work full time (see Section 5)?
the deferment on your FFEL Program loans.
Yes - Continue to Item 5.
Yes - Attach documentation of the deferment.
No - You are not eligible for this deferment.
Skip to Section 3.
No - Continue to Item 2.
5. What is your monthly income?
2. Have you received or are you receiving payments
You must attach documentation of your monthly
under a federal or state public assistance program
income. Monthly income is either (you choose):
that supports the period of time for which you are
• Your gross income from all sources or
applying for this deferment?
Qualifying programs include: Temporary
• One-twelfth of the Adjusted Gross Income from
Assistance for Needy Families (TANF), Supplemental
your most recent federal income tax return.
Security Income (SSI), Supplemental Nutrition
Assistance Program (SNAP), state general public
6. What is your family size (see section 5)?
assistance, or other means-tested benefits.
Yes - Attach documentation of the payments.
7. Is the amount you reported in Item 5 less than 150%
Skip to Section 3.
of the poverty guideline for your family size and
No - Continue to Item 3.
state of residence (see Table 2 in Section 5)?
Yes - Continue to Section 3.
No - You are not eligible for this deferment.
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