Temporary Hardship Forbearance Form

If you need to postpone the payment of an amount of money that has been borrowed before default due to the occurrence of extreme issues or circumstances in your life, you are required to file the following form with the related financial institution.

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First Name:
Middle Initial:
Last Name:
Suffix (Jr, Sr, etc.):
SECTION 1: BORROWER INFORMATION	
If your address or telephone number has changed, indicate the changes in\
 SECTION 5 of this form.	
If your name has changed, include a copy of one of the following: Driver's License, Social Security Card, Marriage License,  Divorce Decree or Court Order.	
SECTION 2: FORBEARANCE INFORMATION
SECTION 3: FORBEARANCE AGREEMENT
Although my situation  at the  present  time is preventing  me from  making  regularly  scheduled  payments,  I intend  and agree  to repay  my loan(s)  according  to the  terms 
and  conditions  of my  promissory  note.  During  the forbearance  period, I am  responsible  for the  accrued  interest on my  loan(s).   Any  unpaid  interest  will be capitalized 
(added  to the  principal  balance) when the forbearance  ends.  Payments  will resume  within 60 days  of the  forbearance  end date.   The  exact  amount  of the  monthly 
payments will be calculated in accordance with all applicable laws gover\
ning student loans. 
   I understand  the forbearance  I am  requesting  will not be granted  for more  than 12 months  at one  time.   I  understand  that if I qualify  for the  above  forbearance,  I 
authorize  FedLoan Servicing  to extend  and/or backdate  a Temporary  Hardship Forbearance  (not to exceed  12 months)  to ensure  any past  due amount  on my  loan(s)  is 
covered.   For  an account  that is delinquent,  the forbearance  can be applied  retroactively  to cover  the period  of delinquency;  however, any negative  reports that were 
submitted  to the  consumer  reporting agencies will not be removed.   I  understand  that should  my situation  under which  I applied  for this  forbearance  change, I must 
notify FedLoan Servicing. 
   By  providing  a telephone  number(s),  I am  expressly  consenting  to my  schools,  Department  of Education,  servicer, guarantor,  owner, holder of my  loan(s)  or any  of their 
respective  agents or affiliates  to contact  me via automatic  telephone  dialing system  or similar  device and/or  using a prerecorded  or artificial  voice or message  and/or by 
text  message  utilizing the telephone  number(s)  I provide  which are associated  with any wireless  (mobile/cellular)  phone or similar  device or any  other  type of telephone 
number (including VoIP) regardless of the purpose of the communication\
, even if such a communication incurs an access fee/charge from my provi\
der/plan. 
 
The information provided is true and correct to the best of my knowledge\
.
Borrower's Signature	Co-Maker's Signature (If applicable - See information in SECTION 4)	Date	
 I intend to repay my loan(s); however, I am unable to make the monthly\
 installment payment on my loan(s) due to 	 	
  financial difficulty.	
I request my Temporary Hardship Forbearance to end on: 	/	
Return Completed Form To: 
FedLoan Servicing, P.O. Box 69184, Harrisburg, PA 17106-9184  Fax 717-720-1628	
TIV-HDF-OCR-W-V.0311	
MMYY	
(Please Type Information)	
Account Number:	
Records Code: HDFRB - XFRB  
Form Code:     FD-HRD 
Version Date:  03/18/11	
HDF	
Temporary Hardship Forbearance Request	
Temporary Hardship -	
This discretionary forbearance option is granted to borrowers who intend\
 to repay their loan(s) but are experiencing financial difficulty and \
show that repayment of their 
student loan(s) at the present time would constitute a hardship.

SECTION 4: ADDITIONAL INFORMATION
CO-MAKER INFORMATION If there is a co-maker(s) on the loan(s) for which you are requestin\
g a forbearance, the co-maker(s) must apply and be eligible for the sa\
me or different forbearance type during the same period 
of time in order for you to obtain a forbearance.  If the co-maker is ap\
plying for the same forbearance type, one form may be used as long as bo\
th signatures are present.  If the co-maker is 
applying for a different forbearance type, two forms are required. 
  
DIRECT DEBIT BORROWERS If you  are currently  using Direct  Debit,  our Electronic  Funds Transfer  service, and will not have  the funds  available  for your  next scheduled  debit, call us at least  3 business  days prior  to your  due 
date to have the next scheduled debit suspended.  This should allow you \
time to submit your forbearance request.  However, keep in mind that you\
 are responsible for all of your monthly  
installments until your request for forbearance is approved.  
  
EXPLANATION OF INTEREST CAPITALIZATION Capitalization of interest is the addition of outstanding accrued intere\
st to the current principal balance of the loan(s).  Capitalization of\
 interest results in a higher principal balance and  
additional finance charges over the course of repayment and may cause yo\
ur monthly payment amount to increase.  FedLoan Servicing will automatic\
ally capitalize outstanding interest at the 
expiration of a forbearance period.  However, while your account is in f\
orbearance, you will receive periodic notices advising you of the amount\
 of interest which has accrued on your loan(s).  
These notices give you the opportunity to satisfy outstanding interest b\
efore capitalization.  
SECTION 5: ADDRESS INFORMATION	
Account Number:	
Street Address Line 1:
Street Address Line 2:
City:	State:	Zip Code:	
Home Phone:	Ext:	
Email Address:
Foreign State:	Foreign Country:	
For More Information Visit Our Website at www.myfedloan.org	 or call us toll free at 1-800-699-2908.	
TIV-HDF-OCR-W-V.0311	
Country Code: 	City  Code: 	Local Code: 	Extn Code: 
Foreign Phone:	
Alternate Phone: