Income Driven Repayment Form
Income Driven Repayment Form
Income Driven Repayment Form
Complete
Your
For Revised Pay As You Earn (REPAYE), Pay As You Earn (PAYE), Income-Based Repayment (IBR), and
Income-Contingent Repayment (ICR) plans
SECTION 5: Continued
Note: If your spouse has loans with Great Lakes and would like to
apply for an income-driven repayment plan, they must complete a
separate application.
mygreatlakes.org/go/submitforms
Mobile App:
Mail:
Great Lakes
PO Box 7860
Madison, WI 53707-7860
Fax:
Call:
Online:
mygreatlakes.org
4195 (10/15)
For the Revised Pay As You Earn (REPAYE), Pay As You Earn (PAYE), Income-Based
(IBR), and Income-Contingent (ICR) repayment plans under the William D. Ford
Federal Direct Loan (Direct Loan) and Federal Family Education Loan (FFEL) Programs
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.
REPAYE
IBR
PAYE
ICR
No - Continue to Item 5.
Yes, but I want to start making payments under my plan
immediately - Continue to Item 5.
Yes, but I do not want to start repaying my loans until
the deferment or forbearance ends - Continue to Item 5.
If you have FFEL Program loans, they may only be repaid under IBR. If you request a different plan, your loan holder will
consider you for IBR on your FFEL Program loans. You may be able to consolidate your FFEL Program loans into a Direct
Consolidation Loan to take advantage of other income-driven plans by visiting StudentLoans.gov.
4194 (10/15)
Page 1 of 12
*RN847622891FO004194NP5*
Borrower Name:
WALTER S RAMOS
Borrower SSN:
. Continue to Item 6.
A definition of "family size" is available in Section 9.
Do not enter a value for you or your spouse. Those
values are automatically included, if appropriate.
No - Skip to Section 6.
b. Spouse's Name
c. Spouse's Date of Birth
13. If you are placed on the ICR plan, do you want to
repay your Direct Loans jointly with your spouse?
Yes - Continue to Item 14.
No - Continue to Item 14.
14. When you filed your last federal income tax return,
did you file jointly with your spouse?
Yes - Continue to Item 15.
Page 2 of 12
Borrower Name:
WALTER S RAMOS
Borrower SSN:
SECTION 4B: LOAN AND INCOME INFORMATION FOR MARRIED BORROWERS (CONTINUED)
24. Are you reasonably able to access information
about your spouse's income and able to have your
spouse sign this application?
Yes - Continue to Item 25.
No - Skip to Section 6.
20. Did you file a federal income tax return for either
of the past two years?
Yes - Continue to Item 21.
25. Did your spouse file a federal income tax return for
either of the past two tax years?
No - Skip to Section 6.
Remember, any person who makes a knowingly false statement or misrepresentation on this form may be subject
to fines, imprisonment, or both.
Page 3 of 12
Borrower Name:
WALTER S RAMOS
Borrower SSN:
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.
Borrower's Signature
Date:
Spouse's Signature
Date:
If you are married, your spouse is required to sign this form unless you answered "yes" to Item 23 or "no" to Item 24.
Great Lakes ID: 84-7622891
Page 4 of 12
Great Lakes
PO Box 7860
Madison, WI 53707-7860
Fax: (800) 375-5288 or (608) 246-1608
SECTION 9: DEFINITIONS
COMMON DEFINITIONS FOR ALL INCOME-DRIVEN
REPAYMENT PLANS:
The William D. Ford Federal Direct Loan (Direct Loan)
Program includes Direct Subsidized Loans, Direct
Unsubsidized Loans, Direct PLUS Loans, and Direct
Consolidation Loans.
The Federal Family Education Loan (FFEL)
Program includes Federal Stafford Loans (both
subsidized and unsubsidized), Federal PLUS Loans,
Federal Consolidation Loans, and Federal
Supplemental Loans for Students (SLS).
The poverty guideline amount is the figure for
your state and family size from the poverty guidelines
published annually by the U.S. Department of Health
and Human Services (HHS). The HHS poverty
guidelines are used for purposes such as determining
eligibility for certain federal benefit programs. If you
are not a resident of a state identified in the poverty
guidelines, your poverty guideline amount is the
amount used for the 48 contiguous states.
Family size always includes you and your children
(including unborn children who will be born during the
year for which you certify your family size), if the
children will receive more than half their support from
you.
For the PAYE, IBR, and ICR Plans, family size also
always includes your spouse. For the REPAYE plan,
family size includes your spouse unless your spouse's
income is excluded from the calculation of your
payment amount because you are (1) separated from
your spouse or (2) unable to access your spouse's
income information.
Eligible loans for the IBR plan are Direct Loan and
FFEL Program loans other than: (1) a loan that is in
default, (2) a Direct or Federal PLUS Loan made to a
parent borrower, or (3) a Direct or Federal
Consolidation Loan that repaid a Direct or Federal
PLUS Loan made to a parent borrower. Federal
Perkins Loans, HEAL loans or other health education
loans, and private education loans are not eligible to
be repaid under the IBR plan.
You are a new borrower for the IBR plan if (1) you
have no outstanding balance on a Direct Loan or FFEL
Program loan as of July 1, 2014 or (2) have no
outstanding balance on a Direct Loan or FFEL Program
loan when you obtain a new loan on or after July 1,
2014.
Page 7 of 12
REPAYE
PAYE
IBR
Generally, 15% of
discretionary income.
ICR
Lesser of 20% of
discretionary income or
what you would pay under
a repayment plan with
fixed payments over 12
years, adjusted based on
your income.
Cap on Payment Amount None. Your payment may
What you would have paid
What you would have paid
None. Your payment may
What you would have paid
exceed what you would have
under the standard
under the standard
exceed what you would
under the standard
paid under the standard
repayment plan with a 10repayment plan with a 10have paid under the
repayment plan with a 10repayment plan with a 10-year year repayment period when year repayment period when year repayment period when standard repayment plan
repayment period.
you entered the plan.
you entered the plan.
with a 10-year repayment
you entered the plan.
period.
You must provide income
You must provide income
You must provide income
You must provide income
You must provide income
documentation for yourself and documentation for you and documentation for you and documentation for you and documentation for you and
your spouse regardless of
your spouse only if you file a your spouse only if you file a your spouse only if you file a your spouse only if you file
whether you file a joint or
joint Federal income tax
joint Federal income tax
joint Federal income tax
a joint Federal income tax
separate Federal income tax
return.
return.
return.
return or if you and your
Married Borrowers
return unless you and your
spouse choose to jointly
spouse (1) are separated or (2)
repay under the plan.
you are unable to reasonably
access your spouse's income
information.
Borrower Responsibility On subsidized loans, you do
On subsidized loans, you do On subsidized loans, you do On subsidized loans, you do You are responsible for
for Interest if Payment
not have to pay the
not have to pay the difference paying all of the interest
not have to pay the difference not have to pay the
Does Not Cover All
difference between your
difference between your
between your monthly
that accrues.
between your monthly
Interest that Accrues
monthly payment amount
monthly payment amount
payment amount and the
payment amount and the
and the remaining interest
and the remaining interest
remaining interest that
remaining interest that
that accrues for your first 3
that accrues for your first 3 accrues for your first 3
accrues for your first 3
consecutive years of
consecutive years of
consecutive years of
consecutive years of
repayment under the plan.
repayment under the plan. repayment under the plan.
repayment under the plan.
On subsidized loans after the
first consecutive 3 years and
on unsubsidized loans during
all periods, you are only
responsible for paying half of
the difference between your
monthly payment amount and
the remaining interest that
accrues.
Page 8 of 12
SECTION 10: INCOME-DRIVEN PLAN ELIGIBILITY REQUIREMENTS AND GENERAL INFORMATION (CONTINUED)
Plan Feature
Forgiveness Period
REPAYE
PAYE
IBR
ICR
None.
None.
You must be a Direct Loan
borrower with eligible loans.
Page 9 of 12
SECTION 10: INCOME-DRIVEN PLAN ELIGIBILITY REQUIREMENTS AND GENERAL INFORMATION (CONTINUED)
Plan Feature
REPAYE
PAYE
IBR
ICR
At any time, you may change If you want to leave the plan,
to any other repayment plan you will be placed on the
for which you are eligible.
standard repayment plan. You
may not change to a different
plan until you have made at
least one payment under the
standard repayment plan or a
payment under a reducedpayment forbearance.
If you want to leave the plan, At any time, you may change
you will be placed on the
to any other repayment plan
standard repayment plan. You for which you are eligible.
may not change to a different
plan until you have made at
least one payment under the
standard repayment plan or a
payment under a reducedpayment forbearance.
Interest
Capitalization
You must again show that you You must again show that you No restrictions.
have a partial financial
have a partial financial
hardship.
hardship.
Page 10 of 12
Initial
Payment
Final
Time in
Payment Repayment
Total
Paid
Loan
Forgiveness
Repayment Plan
Initial
Payment
Final
Time in
Loan
Total Paid
Payment Repayment
Forgiveness
Standard
$333
$333
10 years
$39,967
N/A
Standard
$666
$666
10 years
$79,935
N/A
Graduated
$190
$571
10 years
$42,636
N/A
Graduated
$381
$1,143
10 years
$85,272
N/A
Ineligible
Extended-Fixed
$387
$387
25 years
$115,974
N/A
Ineligible
$300
$582
25 years
$126,173
N/A
$61
$299
20 years
$38,714
$27,164
$186
$615
20 years
$88,314
$41,008
REPAYE
$61
$299
20 years
$38,714
$23,672
REPAYE
$186
$819
IBR
$92
$333
$0
IBR
$279
$666
ICR
$197
$255
$0
ICR
$471
$586
Extended-Fixed
ExtendedGraduated
PAYE & IBR (new
borrowers)
21 years, 6
$60,441
months
19 years, 2
$51,838
months
ExtendedGraduated
PAYE & IBR (new
borrowers)
Page 11 of 12
24 years,
$131,061
11 months
18 years, 1
$107,385
month
13 years, 8
$89,152
months
$0
$0
$0
Page 12 of 12