Internship/Residency, National Guard Duty, DOD Loan Repa

MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on
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.
You never need to pay for help with your federal student loans. Your loan servicer will help you for FREE.
Contact your servicer if you have questions about this form or need any information regarding your
federal student loans.
SECTION 1: BORROWER INFORMATION
Please enter or correct the following information.
Check this box if any of your information has changed.
Social Security Number (SSN) _________________________________________
Date of Birth (mm-dd-yyyy) _________________________________________
Name __________________________________________________________________
Address __________________________________________________________________
City _________________________________________
State ____________
Zip Code ____________
Phone – Primary ___________________________________
Phone - Alternate___________________________________
Email ___________________________________
SECTION 2: BORROWER DETERMINATION OF FORBEARANCE ELIGIBILITY
Carefully read the entire form before completing it. Complete the applicable part of Section 2 in its
entirety. This form covers three different types of forbearance. Review the information for each
forbearance type to determine whether you qualify for that forbearance.
PART A. MEDICAL OR DENTAL INTERNSHIP/RESIDENCY
You only qualify for this forbearance if you do not qualify for a medical or dental internship/residency
deferment.
1. Have you been accepted into an internship/residency program?
Yes - Continue to Item 2.
No - You are not eligible for this forbearance.
Page 1 of 9
DRAFT9/25/2024

MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

2. Did your program require for admission that you have a bachelor's degree?
Yes - Continue to Item 3.
No - You are not eligible for this forbearance.
3. Will you receive supervised training in your internship/residency program?
Yes - Continue to Item 4.
No - You are not eligible for this forbearance.
4. Will completion of your program lead to a degree or certificate awarded by an institution of higher
education, a hospital, or a health care facility that offers postgraduate training?
Yes - Complete Section 3 and have an authorized official complete Section 4.
No - Continue to Item 5.
5. Is completion of all or a portion of the program required before you can begin professional practice or
service?
Yes - Complete Section 3 and have an authorized official complete Section 4. In addition, you must
attach a separate statement from the appropriate state licensing agency certifying this requirement.
No - You are not eligible for this forbearance.
PART B. NATIONAL GUARD DUTY
You only qualify for this forbearance if you do not qualify for a military service deferment.
6. Are you a member of the National Guard?
Yes - Continue to Item 7.
No - You are not eligible for this forbearance.
7. Are you engaged in active state duty for a period of more than 30 consecutive days because a
governor activated you based on state statute or policy?
Yes - Continue to Item 8.
No - Skip to Item 9.
8. Is your service being paid for with state funds?
Yes - Skip to Item 11.
No - Continue to Item 9.
Page 2 of 9
DRAFT9/25/2024

MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

9. Are you engaged in active state duty for a period of more than 30 consecutive days under which a
governor activated you with the approval of the President or the U.S. Secretary of Defense?
Yes - Continue to Item 10.
No - You are not eligible for this forbearance.
10. Is your service being paid for with federal funds?
Yes - Continue to Item 11.
No - You are not eligible for this forbearance.
11. Were you activated no more than 6 months after the last date on which you were enrolled in school
at least half-time?
Yes - Complete Section 3 and have an authorized official (a commanding or personnel officer)
complete Section 4.
No - You are not eligible for this forbearance.
PART C. DEPARTMENT OF DEFENSE STUDENT LOAN REPAYMENT PROGRAM
12. Are you performing service that qualifies you for a partial repayment of your loans under any
Department of Defense Student Loan Repayment Program?
Yes - Complete Section 3 and have an authorized official from the Department of Defense complete
Section 4.
No - You are not eligible for this forbearance.
SECTION 3: BORROWER REQUESTS, UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION
I request:
•

My loan holder grant forbearance for the period during which I meet the qualifications for the
forbearance. If approved for a forbearance, I would like to:
Temporarily stop making payments; or
Make smaller payments in the amount of _____________ per month.

•
•

My loan holder grant my forbearance for up to 12 months unless I specify an earlier end date:
(mm-dd-yyyy)___________ .
If checked, to make interest payments on my loans during forbearance.

I understand:
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MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

•

I am not required to make payments of loan principal or interest during forbearance.

•

My forbearance will begin on the later of the date my loan holder determines, or the date the
program or service that qualifies me for forbearance began, as certified by the authorized
official.

•

My loan holder may grant me an additional forbearance while processing my form or to
cover any period of delinquency that exists when I submit my form.

•

My forbearance will end on the earlier of the date I am no longer eligible for the forbearance,
12 months from the start date of the forbearance, or the end date I requested.

•

My forbearance will only be granted in increments of up to 12 months, and I must reapply
for the forbearance if I continue to meet the eligibility requirements and want to extend my
forbearance.

•

Interest may capitalize on my FFEL Program loans that are not held by the Department
during or at the expiration of my forbearance.

I certify that:
•

The information I have provided on this form is true and correct.

•

I will provide additional documentation to my loan holder, as required, to support my
forbearance eligibility.

•

I will notify my loan holder immediately when my eligibility for the forbearance ends.

•
•

I have read, understand, and meet the eligibility requirements in Section 2.
I will repay my loans according to the terms of my promissory note, even if my request is not
granted.

I authorize the entity to which I submit this request and its agents to contact me regarding my request
or my loans at any cellular telephone number that I provide now or in the future using automated
telephone dialing equipment or artificial prerecorded voice or text messages.
Borrower’s Signature ____________________________________________________
Date (mm-dd-yyyy)____________________________________________
SECTION 4: AUTHORIZED OFFICIAL'S CERTIFICATION
Do not complete this section unless the borrower has completed the applicable part of Section 2 in its
entirety. Note: As an alternative to having an authorized official complete this section, you may attach
separate documentation from an authorized official that includes all of the information requested below
Page 4 of 9
DRAFT9/25/2024

MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

and a certification that you and the program meet all conditions indicated by your responses in Section
2. For the National Guard Duty forbearance, you may attach a copy of your orders.
•
•

The program/service begins/began on: (mm-dd-yyyy)_________________________
The program/service is expected to end/ended on: (mm-dd-yyyy)______________________

I certify, to the best of my knowledge and belief, that:
•
•
•

The borrower named above is/was engaged in the program/service indicated in Section 2;
The borrower and program/service meet all conditions indicated by the borrower's responses in
Section 2; and
The information that I have provided in this section is accurate.

Name of Institution/Organization ________________________________________________________
Address ____________________________________________________________________________
City ______________________________________________________
State ___________
Zip Code ___________
Official's Name/Title ___________________________________________________________________
Phone __________________________________
Official's Signature ___________________________________________________________
Date (mm-dd-yyyy)____________________________________________
SECTION 5: INSTRUCTIONS FOR COMPLETING THE FORM
Type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Example: March 14, 2024 =
03-14-2024. Include your name and account number on any documentation that you submit with this
form. If you want to apply for a forbearance on loans that are held by different loan holders, you must
submit a separate forbearance request to each loan holder. Return the completed form and any
required documentation to the address shown in Section 7.
If you are an endorser, you may request forbearance only when you are required to repay the loan
because the borrower is not making payments. If you have a loan that was made jointly to you and your
spouse (as co-makers), both of you must individually meet the requirements for a forbearance and each
of you must submit a separate forbearance request.
SECTION 6: DEFINITIONS
The William D. Ford Federal Direct Loan (Direct Loan) Program includes Federal Direct Stafford/Ford
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MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

(Direct Subsidized) Loans, Federal Direct Unsubsidized Stafford/Ford (Direct Unsubsidized) Loans,
Federal Direct PLUS (Direct PLUS) Loans, and Federal Direct Consolidation (Direct Consolidation) Loans.
The Federal Family Education Loan (FFEL) Program includes Federal Stafford Loans, Federal PLUS Loans,
Federal Consolidation Loans, and Federal Supplemental Loans for Students (SLS).
An authorized official for the medical or dental internship/residency forbearance is an official from your
internship/residency program. An authorized official for the National Guard State Duty forbearance is
your commanding or personnel officer. An authorized official for the Department of Defense Student
Loan Repayment Program forbearance is an official from the Department of Defense.
Capitalization is the addition of unpaid interest to the principal balance of a Direct Loan Program or FFEL
Program. Capitalization causes more interest to accrue over the life of the loan and may cause your
monthly payment amount to increase. The Capitalization Chart below provides an example of the
monthly payments and the total amount repaid for a $30,000 unsubsidized FFEL Program loan. The
example loan has a 6% interest rate and the example forbearance lasts for 12 months and begins when
the loan entered repayment. The example compares the effects of paying the interest as it accrues or
allowing it to capitalize.
A co-maker is one of the two individual who are joint borrowers on a Direct or Federal Consolidation
Loan or a Federal PLUS Loan. Both co-makers are equally responsible for repaying the full amount of the
loan.
A deferment is a period during which you are entitled to postpone repayment of your loans. Interest is
not charged to you during a deferment on your subsidized loans. Interest is always charged to you
during a deferment on your unsubsidized loans. Unpaid interest that accrues during a deferment on an
unsubsidized Direct Loan or on an unsubsidized FFEL Program loan that is held by the Department is
capitalized at the end of the deferment period. Unpaid interest that accrues during a deferment on a
FFEL Program loan that is not held by the Department is capitalized at the end of the deferment but may
be capitalized as frequently as quarterly on loans disbursed prior to 7/1/2000.
An endorser is an individual who agrees to repay a Direct PLUS Loan or Federal PLUS Loan if the
borrower does not repay the loan.
A forbearance is a period during which you are permitted to postpone making payments temporarily,
allowed an extension of time for making payments, or temporarily allowed to make smaller payments
than scheduled. Interest is charged during a forbearance on both subsidized and unsubsidized loans.
Unpaid interest that accrues during a forbearance on a Direct Loan or on a FFEL Program loan that is
held by the Department is not capitalized. Unpaid interest that accrues during a forbearance on a FFEL
Program loan that is not held by the Department may be capitalized at the end of the forbearance but
may be capitalized as frequently as quarterly on loans disbursed prior to 7/1/2000.
Page 6 of 9
DRAFT9/25/2024

MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

The holder of your Direct Loans is the Department. The holder of your FFEL Program loans may be a
lender, guaranty agency, secondary market, or the Department. The holder of your Perkins Loans is an
institution of higher education or the Department. Your loan holder may use a servicer to handle billing
and other communications related to your loans. References to “your loan holder” on this form mean
either your loan holder or your servicer.
A subsidized loan is a Direct Subsidized Loan, a Direct Subsidized Consolidation Loan, a Federal
Subsidized Stafford Loan, and portions of some Federal Consolidation Loans.
An unsubsidized loan is a Direct Unsubsidized Loan, a Direct Unsubsidized Consolidation Loan, a Direct
PLUS Loan, a Federal Unsubsidized Stafford Loan, a Federal PLUS Loan, a Federal SLS, and portions of
some Federal Consolidation Loans.
Capitalization Chart (Note: this chart only applies to FFEL Program loans that are not held by the
Department)
Treatment of Interest
with Forbearance

Loan
Amount

Capitalized Outstanding
Interest
Principal

Monthly
Payment

Interest is paid

$30,000

$0

$30,000

$333

Interest is capitalized at
the end

$30,000

$1,800

$31,800

$353

SECTION 7: WHERE TO SEND THE COMPLETED APPLICATION
Return the completed form and any documentation to:
(If no address is shown, return to your loan holder.)

SECTION 8: HELP WITH COMPLETING THE APPLICATION
If you need help completing this form, call:
(If no phone number is shown, call your loan holder.)

SECTION 9: IMPORTANT NOTICES
Privacy Act Statement.
Page 7 of 9
DRAFT9/25/2024

Number
Total
of
Repaid
Payments
120
$41,767
120

$42,365

MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

Authority: The authorities for collecting the requested information from and about you are §421 et seq.
or §451 et seq. of the Higher Education Act of 1965, as amended (20 U.S.C. 1071 et seq. or 20 U.S.C.
1087a et seq.) and the authorities for collecting and using your Social Security Number (SSN) are
§§428B(f) and 484(a)(4) of the HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31 U.S.C. 7701(b).
Participating in the William D. Ford Federal Direct Loan (Direct Loan) Program or Federal Family
Education Loan (FFEL) Program and giving us your SSN are voluntary, but you must provide the
requested information, including your SSN, to participate.
Purpose: The principal purposes for collecting the information on the Mandatory Forbearance Request
form for Medical or Dental Internship/Residency, National Guard Duty, or Department of Defense
Student Loan Repayment Program Forbearance, including your SSN, are to verify your identity, to
determine your eligibility to receive a loan or a benefit on a loan (such as a deferment, forbearance,
discharge, or forgiveness) under the FFEL and/or Direct Loan Programs, to permit the servicing of your
loans, to enforce the conditions or terms of a title IV, HEA obligation, to originate, disburse, service,
collect, assign, adjust, transfer, refer, furnish credit information for, and discharge a title IV, HEA
obligation, to verify whether a title IV, HEA obligation qualifies for discharge, to determine credit
balances to be refunded by the U.S. Department of the Treasury (Treasury) to the individual or loan
holder, and, if it becomes necessary, to locate you and to collect and report on your loans if your loans
become delinquent or default. We also use your SSN as an account identifier and to permit you to
access your account information electronically.
Disclosures: The information provided on the Mandatory Forbearance Request form Medical or Dental
Internship/Residency, National Guard Duty, or Department of Defense Student Loan Repayment
Program Forbearance will only be disclosed outside of the U.S. Department of Education (Department)
with prior written consent or as otherwise allowed by the Privacy Act of 1974, as amended (Privacy Act)
(5 U.S.C. 552a). One of the exceptions to the Privacy Act’s prior written consent requirement that allows
for disclosure, without consent, is for “routine uses” that the Department publishes in our System of
Records Notices (SORNs). The Department may disclose, without consent, the information provided on a
Graduate Fellowship Deferment form, on a case-by-case basis or under a computer matching program,
to third parties pursuant to the routine uses identified in the “Common Services for Borrowers (CSB)
System” (18-11-16) SORN. This notice is available on the Department’s “Privacy Act System of Record
Notice Issuances (SORN)” webpage located at https://www2.ed.gov/notices/ed-pia.html.
These routine uses include, but are not limited to, the following:
•

To verify the identity of the individual who records indicate has applied for or received title IV,
HEA program funds, disclosures may be made to guaranty agencies, educational and financial
institutions, and their authorized representatives; to Federal, State, Tribal, or local agencies, and
their authorized representatives; to private parties, such as relatives, business and personal
associates, and present and former employers; to creditors; to consumer reporting agencies; to
Page 8 of 9
DRAFT9/25/2024

MANDATORY FORBEARANCE REQUEST
Medical or Dental Internship/Residency, National Guard Duty, or
Department of Defense Student Loan Repayment Program Forbearance
William D. Ford Federal Direct Loan (Direct Loan Program) / Federal Family
Education Loan (FFEL) Program

•

•

OMB No. 1845-0018
Form Under Review
Expiration Date
xx/xx/xxxx

adjudicative bodies; and to the individual whom the records identify as the party obligated to
repay the title IV, HEA obligation;
To determine program eligibility and benefits, disclosures may be made to guaranty agencies,
educational and financial institutions, and their authorized representatives; to Federal, State, or
local agencies, and their authorized representatives; to private parties, such as relatives,
business and personal associates, and present and former employers; to creditors; to consumer
reporting agencies; and to adjudicative bodies;
To provide customers with information to help them make informed decisions on repayment
options, including deferment, forbearance, and recurring auto debit, based on their unique
situations, disclosures may be made to guaranty agencies, educational and financial institutions,
and their authorized representatives; and to Federal, State, or local agencies, and their
authorized representatives.

For additional routine uses, view the “Common Services for Borrowers (CSB) System” (18-11-16) SORN.
This notice is available on the Department’s “Privacy Act System of Record Notice Issuances (SORN)”
webpage located at https://www2.ed.gov/notices/ed-pia.html.
Consequences of Failure to Provide Information: Participating in the Federal Family Education Loan
(FFEL) Program or the William D. Ford Federal Direct Loan (Direct Loan) Program and providing the
Department your SSN and requested information is mandatory to participate
Paperwork Reduction Notice. According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such collection displays a valid OMB control
number. The valid OMB control number for this information collection is 1845-0018. Public reporting
burden for this collection of information is estimated to average 15 minutes per response, including
time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. The obligation to respond to this
collection is required to obtain a benefit in accordance with 34 CFR 682.211 or 685.205.
If you have comments or concerns regarding the status of your individual submission of this form,
contact your loan holder directly.

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