Revised January 2013

Forms Status Chart

NCHER Forms Subcommittee

Standards and Operations Committee

# / Expiration Date/ OMB Version # / Form Name / Program(s) / Comments/Federal Register and DCL Notices / Workgroup Leader
1. / 07/31/2013
1845-0080-v.2 / Deferment Request:
  • Military Service Deferment
  • Post-Active Duty Student Deferment
(MIL) / FFEL/DL/Perkins / Published 11/26/10 FP-10-07
Workgroup currently discussing initial comments / Lynn Racculia
2. / 08/31/2010
(04340)1845-0014-v.5 / Repayment Plan Selection / DL / 60-day Notice FR 6/21/10
30-day Notice FR 8/25/10
NCHELP sent community recommendations to ED regarding combination FFEL/DL Repayment Selection form on 10/18/2010
As of 4/1/2013, the DL form may only be used to request Standard, Graduated or Extended repayment plans.
A combined FFEL/DL IBR / Pay As You Earn / ICR Repayment Request waspublished December 19, 2012. / Darin Katzberg
3. / 08/31/2010
(04340)1845-0014-v.5
Obsolete / Federal Direct PLUS Loan Application and Master Promissory Note (with Endorser Addendum) / DL / As of 12/31/2011, this form is obsolete.
The form was replaced by the revised Federal Direct PLUS Loan Application and Master Promissory Note (Direct PLUS MPN) OMB 1845-0068.
3.A. / 11/30/2013
1845-0068-v.1 / Revised Federal Direct PLUS Loan Application and Master Promissory Note (with Endorser Addendum) (Direct PLUS MPN)
The Plain Language Disclosure (PLD) was also revised to reflect the changes contained in the revised Direct PLUS MPN. / DL / Published 8/3/2011
AS of 1/1/2012, only the revised Direct PLUS MPN will be accepted. / Sheryl Ross-Mahoney
4. / 11/30/2010
(03429)1845-0053 –v.5 / Federal Direct Consolidation Loan Application and Promissory Note (with Loan Verification Certificate, Request to Add Loans, and Additional Loan Listing Sheet) / DL / 60-day Notice FR 9/14/10
FP- 7-03 March 12, 2007 / Sheryl Ross-Mahoney
5. / 11/30/2010
(04309)1845-0104-v.1 / Civil Legal Assistance Attorney Student Loan Repayment Program: Application to Participate and Service Agreement Annual Certification of Employment / FFEL/DL/Perkins / Request for emergency clearance FR Notice 5/19/10
Federal Register July 7, 2010 / Michelle Anderson
6. / 05/31/2014
(03533)1845-0059-v.6 /
  • Teacher Loan Forgiveness Application
  • Teacher Loan Forgiveness Forbearance Request
/ FFEL/DL / Published August 15, 2012 GEN-12-16 / Michelle Anderson
7. / 04/31/2011
(03546)1845-0058-v.3 / Loan Discharge Application: Unpaid Refund / FFEL/DL / 60-day FR Notice 2/14/2011
30-day FR Notice 4/21/2011
FP-11-01 11/22/11
On 3/30/2012 ED published revised word and pdf versions as a few technical corrections were needed to the forms.
8. / 07/31/2014
(03566)1845-0007-v.4 / Federal Direct Stafford/Ford Loan and Federal Direct Unsubsidized Stafford/Ford Loan Master Promissory Note / DL / Published 10-19-2012
9. / 05/31/2011
(04003)1845-0025-v.3 / Electronic Debit Account Application and Brochure / DL
10. / 12/31/2014
(03743)1845-0015-v.5 / Loan Discharge Applications:
  • School Closure
  • False Certification of Ability to Benefit
  • False Certification (Disqualifying Status)
  • Unauthorized Signature/Unauthorized Payment
/ FFEL/DL/Perkins
FFEL/DL
FFEL/DL
FFEL/DL / Published August 14, 2012 in GEN-12-15
11. / 12/31/2011
(03687)1845-0065-v.3 / Loan Discharge Application: Total and Permanent Disability / Perkins/FFEL/DL/TEACH / NCHELP submitted 60-dayand30-day comments.
The approved forms have yet to be published.
FP-10-05 August 16, 2010 / Char Feist
Carol Lindsey
12. / 06/30/2011
(04120)1845-0001-v.15 / Free Application for Federal Student Aid
July 1, 2010 — June 30, 2011 / N/A / 60-day Notice FR 9/16/10
30-day Notice FR 11/9/2012
New form available electronically / Matt McCreary
13. / 07/31/2015
(03916)1845-005-v.5 / Deferment Request Forms:
  • Economic Hardship
  • Education Related
  • In-School
  • Parental Leave/Working Mother
  • PLUS Borrower with Dependent Student
  • Public Service
  • Temporary Total Disability
  • Unemployment
/ FFEL/DL / Published July 30, 2012GEN 12-14 / Lynn Racculia
14. / 05/31/2012
(03919)1845-0011-v.5
See #13 above.
There is now a single set of deferment request forms for use in both FFEL and DL programs. / Deferment Request Forms:
  • Economic Hardship
  • Education Related
  • In-School
  • Parental Leave/Working Mother
  • Public Service
  • Temporary Total Disability
  • Unemployment
/ DL / As of December 31, 2012, only the combined FFEL/DL forms may be provided to customers in either program. / Lynn Racculia
15. / 5/31/2012
(03930) 1845-0018-v.4 / Internship/Residency Forbearance Request
Loan Debt Burden Forbearance Request / DL / As of December 31, 2012, only the combined FFEL/DL Mandatory Forbearance Request form SERV and SLDB forms may be provided to customers. / Corenna Wagner
16. / 06/30/2012
(03967)1845-0016-v.3 / Income Contingent Repayment Plan & Income-Based Repayment Plan Alternative Documentation of Income / DL / As of April 1, 2013, the form may no longer be provided to borrowers.
The combined IBR/Pay As you Earn/ICR FFEL/DL Repayment Plan Request incorporates alternative documentation of income.
17. / 06/30/2012
(03977)1845-0017-v.3 / Income Contingent Repayment Plan &
Income-Based Repayment Plan
Consent to Disclosure of Tax Information / DL
18. / 08/31/2012
(03584)1845-0040-v.3 / Electronic Debit Account (EDA) application / FFEL/DL/Perkins
(defaulted loans held by ED) / NCHELP submitted 30 and 60-day comments
19. / 09/30/2012
1845-0031 / General Forbearance Request / DL
20. / 02/28/2013
1845-0101 / Private Education Loan Self-Certification / N/A / GEN-10-01 February 14, 2010
21. / 11/31/2015
1845-0102-v.1
The form is for use in both the FFEL and DL programs. / Income-Based (IBR) / Pay As You Earn / Income-Contingent (ICR) Repayment Plan Request / FFEL/DL / Published December 19, 2012 GEN-12-22
The new forms must be provided to customers no later than April 1, 2013,
The previous version of the form may be accepted from borrowers through April 30, 2013.
21. / 04/30/2013
(04115)1845-0102-v.1
See #20 / FFEL IBR forms:
  • IBR Request
  • IBR Alternative Documentation of Income
/ FFEL / Published December 19, 2012 GEN-12-22
The new forms must be provided to customers no later than April 1, 2013.
This version of the form may only be accepted from borrowers through April 30, 2013.
22. / 04/30/2013
(04183)1845-0103-v.1 / Federal Direct PLUS Loan Request for Supplemental Information / DL
23. / 11/30/2014
1845-0110
1845-0110 / The Employment Certification Package includes a (1) Dear Borrower Letter, (2) Instructions, and (3) the new form, Employment Certification for Public Services Loan Forgiveness (PSLF), 1845-0110
Employment Certification for Public Service Loan Forgiveness (PSLF)
Instructions for Completing Employment Certification for Public Serivce Loan Forgiveness (PSLF) / DL / Published on January 31, 2012
Published on January 31, 2012
24. / New Form / Loan Discharge Application:
False Certification (Identity Theft) / FFEL/DL / NCHELP submitted initial form in 2007. ED has not published a form.
25. / New Form for limited timeframe. / Federal Special Direct Consolidation Loan Verification Certificate / DL / Published FP-12-1 January 20, 2012.
26. / 7/31/2015
New
1845-0018-v.1
The forms are for use in both FFEL and DL programs. / Mandatory Forbearance Requests
  • Loan Debt Burden Forbearance Request (SLDB)
  • Medical or Dental Internship Internship/Residency Program, National Guard Duty, Department of Defense Loan repayment Program (SERV)
/ FFEL/DL / Published July 30, 2012
GEN 12-14
The Department subsequently provided a corrected version of the SERV to NCHER.
A Q&A document on the use of the new forms is available on the NCHER website. / Corenna Wagner

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