Fillable Income-Driven Repayment Plan Request (Page 4 of 12) in pdf

Borrower Name:

Borrower SSN:

SECTION 6: BORROWER REQUESTS, UNDERSTANDINGS, AUTHORIZATION, AND CERTIFICATION

If I am requesting an income-driven repayment plan or seeking to change between income-driven repayment plans, I request:

• That my loan holder place me on the plan I selected in Section 2 to repay my eligible Direct Loan or FFEL Program loans

held by the holder to which I submit this form.

• If I do not qualify for the plan or plans I requested, that my loan holder place me on the plan with the lowest monthly

payment amount.

• If I selected more than one plan, that my loan holder place me on the plan with the lowest monthly payment amount

from the plans that I requested.

• If more than one of the plans that I selected provides the same initial payment amount, or if my loan holder is

determining which income-driven plans I qualify for and I qualify for more than one of those plans, my loan holder will

use the following order in choosing my plan: REPAYE (if my repayment period is 20 years), PAYE, REPAYE (if my

repayment period is 25 years), IBR and then ICR.

If I am currently repaying my Direct Loans under the IBR plan and am requesting to change to another income-driven plan, I

must be placed on the Standard Repayment Plan, and cannot change to the plan that I requested until I make a payment under

the Standard Repayment Plan or make a payment under a reduced-payment forbearance.

If I check the box below, I request that my loan holder grant me a reduced-payment forbearance for one month so that I can

move from the IBR plan to my new income-driven repayment plan.

(must be at least $5).

I want a one-month reduced-payment forbearance in the amount of

I understand that:

• If I do not provide my loan holder with this completed form and any other required documentation, I will not be placed

on the plan that I requested.

• I may choose a different repayment plan for any student loans that are not eligible for income-driven repayment.

• If I requested a reduced-payment forbearance of less than $5 above, my loan holder will grant my forbearance request

in the amount of $5.

• If I am requesting the ICR plan, my initial payment amount will be the amount of interest that accrues each month on

my loan until my loan holder receives the income documentation needed to calculate my payment amount. If I cannot

afford the initial payment amount, I may request a forbearance by contacting my loan holder.

• If I have FFEL Program loans, my spouse may be required to give my loan holder access to his or her loan information in

the National Student Loan Data System (NSLDS). My loan holder will contact me with further instructions.

• My loan holder may grant me a forbearance while processing my application or to cover any period of delinquency that

exists when I submit my application.

I authorize the loan holder to which I submit this request (and its agents or contractors) to contact me regarding my request or

my loan(s), including repayment of my loan(s), at any 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.

I certify that all of the information I have provided on this form and in any accompanying documentation is true, complete, and

correct to the best of my knowledge and belief.

Date:

Borrower's Signature

Date:

Spouse's Signature

If you are married, your spouse is required to sign this form unless you answered "yes" to Item 23 or "no" to Item 24.

Page 4 of 12

Income-Driven Repayment Plan Request Page 4

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