Income Driven Repayment Plan Request Form

Income-Driven Repayment Plan Request Form

BORROWER INFORMATION

Social Security Number*

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Telephone - Primary*

Telephone - Alternate

Email

REPAYMENT PLAN OR RECERTIFICATION REQUEST

1: Select the reason you are submitting this form (Check only one):*

I want to enter an income-driven plan - Continue to Item 2. I am submitting documentation for the annual recertification of my income-driven payment - Skip to Item 5. I am submitting documentation early to have my income-driven payment recalculated immediately - Skip to Item 5. I want to change to a different income-driven plan - Continue to Item 2.

2. Choose a plan and then continue to Item 3.

(Recommended) I want the income-driven repayment plan with the lowest monthly payment. REPAYE PAYE IBR ICR

3. Do you have multiple loan holders or servicers?

Yes - Submit a request to each holder or servicer. No.

4. Are you currently in deferment or forbearance? After answering, continue to Item 5.

No. Yes, but I want to start making payments under my plan immediately. Yes, and I do not want to start repaying my loans until the deferment or forbearance ends.

FAMILY SIZE INFORMATION

5. How many children, including unborn children, are in your family and receive more than half of their support from you?*

6. How many other people, excluding your spouse and children, live with you and receive more than half of their support from you?*

MARITAL STATUS INFORMATION

7. What is your marital status?*

Single - Skip to Item 11. Married - Continue to Item 8. Married, but separated - You will be treated as single. Skip to Item 11. Married, but cannot reasonably access my spouse's income information - You will be treated as single. Skip to Item 11.

8. Does your spouse have federal student loans?

Yes - Continue to Item 9. No - Skip to Item 10.

9. Provide the following information about your spouse and then continue to Item 10:

a. Spouse's Social Security Number

b. Spouse's Name

First Name

Last Name

c. Spouse's Date of Birth

ex: 09011987

10. When you filed your last federal income tax return, did you file jointly with your spouse?

Yes - Continue to Item 13. No - Skip to Item 17.

INCOME INFORMATION FOR SINGLE BORROWERS AND MARRIED BORROWERS TREATED AS SINGLE

11. Has your income significantly changed since you filed your last federal income tax return?

Yes - Continue to Item 12. No - Provide your most recent federal income tax return or transcript. Skip to Section 6. I haven't filed a federal income tax return in the last two years - Continue to Item 12.

For example, have you lost your job, experienced a drop in income, or gotten divorced, or did you most recently file a joint return with your spouse, but you have since become separated or lost the ability to access your spouse's income information?

12. Do you currently have taxable income?

Yes - Provide documentation of your income. No - You are not required to provide documentation of your income.

Check "No" if you do not have any income or receive only untaxed income.

INCOME INFORMATION FOR MARRIED BORROWERS FILING JOINTLY

13. Has your income significantly changed since you filed your last federal income tax return?

Yes - Skip to Item 15. No - Continue to Item 14. We haven't filed a federal income tax return in the last two years - Skip to Item 15.

For example, have you lost your job or experienced a drop in income?

14. Has your spouse's income significantly changed since your spouse filed his or her last federal income tax return?

Yes - Continue to Item 15. No - Provide your and your spouse's most recent federal income tax return or transcript.

For example, has your spouse lost his or her job or experienced a drop in income?

15. Do you currently have taxable income?

Yes - You must provide documentation of your income. No - You are not required to provide documentation of your income.

Check "No" if you have no taxable income or receive only untaxed income.

16. Does your spouse currently have taxable income?

Yes - Provide documentation of your spouse's income. No - You are not required to provide documentation of your spouse's income.

Check "No" if your spouse has no taxable income or receives only untaxed income.

INCOME INFORMATION FOR MARRIED BORROWERS FILING SEPARATELY

17. Has your income significantly changed since you filed your last federal income tax return?

Yes - Continue to Item 18. No - Provide your most recent federal income tax return or transcript. Skip to Item 19. I haven't filed a federal income tax return in the past two years - Continue to Item 18.

For example, have you lost your job or experienced a drop in income?

18. Do you currently have taxable income?

Yes - You must provide documentation of your income. No.

Check "No" if you have no taxable income or receive only untaxed income. After answering, continue to Item 19.

19. Has your spouse's income significantly changed since your spouse filed his or her last federal income tax return?

Yes - Continue to Item 20. No - Provide your spouse's most recent federal income tax return or transcript. My spouse hasn't filed a federal income tax return in the past two years.

For example, has your spouse lost a job or experienced a drop in income?

20. Does your spouse currently have taxable income?

Yes -Provide documentation of your spouse's income as instructed in that section. No - You are not required to provide documentation of your spouse's income.

Check "No" if your spouse has no taxable income or receives only untaxed income.

Sign and Date

Today's Date

Signature

[clear]

Use your mouse or finger to draw your signature above