Income-Driven Repayment Plan Request Page 2
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Borrower Name:
Borrower SSN:
SECTION 3: FAMILY SIZE INFORMATION
5. How many children, including unborn children, are in
6. How many people, excluding your spouse and children,
your family and receive more than half of their support
live with you, and receive more than half of their
support from you?
from you?
. Continue to Item 6.
. Continue to Item 7.
7. What is your marital status?
A definition of "family size" is available in Section 9.
Do not enter a value for you or your spouse. Those
Single - Continue to Item 8.
values are automatically included, if appropriate.
Married - Skip to Item 11.
SECTION 4A: INCOME INFORMATION FOR SINGLE BORROWERS
10. Do you currently have taxable income? Check "No" if
8. Did you file a federal income tax return for either of
you do not have any income or receive only untaxed
the past two tax years?
income.
Yes - Continue to Item 9.
Yes - Skip to Section 5.
No - Skip to Item 10.
No - Skip to Section 6.
9. Has your income significantly changed since you filed
your last federal income tax return? For example, have
Remember, any person who makes a knowingly false
you lost your job, gotten divorced, or experienced a
statement or misrepresentation on this form may be
drop in income?
subject to fines, imprisonment, or both.
Yes - Continue to Item 10.
No - Provide your most recent federal income tax
return or transcript. Skip to Section 6.
SECTION 4B: LOAN AND INCOME INFORMATION FOR MARRIED BORROWERS
16. Has your income significantly changed since you
11. Does your spouse have federal student loans?
filed your last federal income tax return? For
Yes - Continue to Item 12.
example, have you lost your job or experienced a
No - Skip to Item 14.
drop in income?
12. Provide the following information about your spouse
Yes - Skip to Item 18.
and then continue to Item 13:
No - Continue to Item 17.
a. Spouse's SSN:
17. Has your spouse's income significantly changed since
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your spouse filed his or her last federal income tax
return? For example, has your spouse lost his or her
b. Spouse's Name
job or experienced a drop in income?
Yes - Continue to Item 18.
c. Spouse's Date of Birth
No - Provide your and your spouse's most recent
13. If you are placed on the ICR plan, do you want to
federal income tax return or transcript. Skip to
repay your Direct Loans jointly with your spouse?
Section 6.
Yes - Continue to Item 14.
18. Do you currently have taxable income? Check "No" if
No - Continue to Item 14.
you do not have any income or receive only untaxed
income.
14. When you filed your last federal income tax return,
did you file jointly with your spouse?
Yes - Provide documentation of your income as
Yes - Continue to Item 15.
instructed in Section 5. Continue to Item 19.
No - Continue to Item 19.
No - Skip to Item 20.
15. Did you and your spouse file a federal income tax
Remember, any person who makes a knowingly false
return for either of the past two tax years?
statement or misrepresentation on this form may be
Yes - Continue to Item 16.
subject to fines, imprisonment, or both.
No - Skip to Item 18.
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