The DD2475 Example form serves as a pivotal document for individuals participating in the Department of Defense Educational Loan Repayment Program (LRP), catering to three distinct categories: Active Duty LRP, Health Professionals LRP, and Selected Reserve LRP. Its primary function is to facilitate the administration of financial aid to service members committed to serving while managing their educational loans. Designed with meticulous sections to gather comprehensive servicemember data, loan specifics, and verification from lending institutions, this form ensures accurate processing and compliance with program requirements. Essential features include the need for personal and loan information verification by designated officials, the release of financial details by the lender, and the provision for remarks to include additional pertinent information. With its structured format, the DD Form 2475 not only aims to streamline the application process for repayment assistance but also enforces privacy and data accuracy, underlined by the authority vested by various U.S. Codes and Executive Orders. This underscores the form's crucial role in managing the financial obligations of service members pursuing higher education, demonstrating the government's support for their academic and professional growth amidst their invaluable service.
| Question | Answer |
|---|---|
| Form Name | Dd2475 Form Example |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | how to fill out a 1750, dd 1750 example filled out, us army dd form 1750 sample, how to fill out 1750 |
DOD EDUCATIONAL
LOAN REPAYMENT PROGRAM (LRP)
ANNUAL APPLICATION
CONTROL NO.
LOAN PROGRAM (X one)
ACTIVE DUTY LRP
HEALTH PROFESSIONALS LRP
SELECTED RESERVE LRP
OMB No.
OMB approval expires
Oct 31, 2009
The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.
FORWARD YOUR FORM TO THE ADDRESS LISTED IN SECTION 1, BLOCK a.
PRIVACY ACT STATEMENT
AUTHORITY: 10 USC 2171, 2173, 16301, 16302, and EO 9397, November 1943 (SSN).
PRINCIPAL PURPOSE: To administer the DoD Loan Repayment Program.
ROUTINE USES: Release is restricted to the Department of Education, to the U.S. Public Health Service, to public and private higher educational institutions, to financial institutions, to the Internal Revenue Service, to private bill collection agencies. The information provided may be used in computer matching programs within the DoD or with any other affected Federal Agency for verification to determine your eligibility and/or compliance with the benefit program requirements being applied for herein and to effect recovery of any improper payments made toward delinquent debts owed by a beneficiary or former beneficiary.
DISCLOSURE: Voluntary; however, failure to provide your Social Security Number may delay processing of your LRP application.
1.PERSONNEL OFFICE VERIFICATION (To be completed by the designated personnel officer)
a. FORWARD COMPLETED FORM TO THIS ADDRESS (Include ZIP Code)
b. VERIFYING OFFICIAL.
I certify that this servicemember has performed satisfactorily.
(1)NAME (LAST, FIRST, MIDDLE INITIAL)
(2) SIGNATURE |
(3) DATE SIGNED |
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(YYYYMMDD) |
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2.SERVICEMEMBER DATA (To be completed by servicemember)
a.NAME (Last, First, Middle Initial)
c. SOCIAL SECURITY NO. |
d. TELEPHONE NO. (Incl. Area Code) |
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e. |
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f. TOTAL OF PRIOR |
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PAYMENTS |
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b.ADDRESS (Street, City, State, and ZIP Code)
I authorize the release of my financial data by lender/holder to complete entries in Section 4.
g. SIGNATURE |
h. DATE SIGNED |
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(YYYYMMDD) |
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3.LOAN DATA (To be completed by servicemember)
a.NAME ON THE LOAN (Last, First, Middle initial)
b.ORIGINAL DATE OF PROMISSORY NOTE (YYYYMMDD)
c. ORIGINAL LOAN AMOUNT
d. LOAN |
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OF |
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LOANS |
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e. LOAN ACCOUNT NUMBER
f. LOAN HOLDER NAME
g. LOAN HOLDER ADDRESS (Include ZIP Code)
h.TELEPHONE NUMBER (Include Area Code)
4.LENDER VERIFICATION (To be completed by loan holder)
a. LOAN IN DEFAULT (X one) |
b. UNPAID PRINCIPAL BALANCE |
c. OUTSTANDING BALANCE |
d. ORIGINAL LOAN AMOUNT |
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YES |
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NO |
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e. NAME AND ADDRESS OF INSTITUTION WHERE PAYMENT IS TO BE |
f. FEDERAL TAX IDENTIFICATION NO. |
g. TYPE OF LOAN (See Instructions) |
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SENT (Include ZIP Code) |
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h. IS THIS A CON- |
i. LOAN INTEREST |
j. LOAN FEES |
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SOLIDATED LOAN? |
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YES |
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NO |
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k.CERTIFYING OFFICER.
As an official of the holding institution, I verify that this information is correct and current. Copy of the promissory note is enclosed.
(1)NAME (Last, First, Middle Initial)
(2) TITLE
(3) SIGNATURE
(4)DATE SIGNED (YYYYMMDD)
FORWARD THIS FORM TO THE ADDRESS LISTED IN SECTION 1, BLOCK A.
5.REMARKS (Continue on back if necessary)
DD FORM 2475, NOV 2006 |
PREVIOUS EDITION IS OBSOLETE. |
FormFlow/Adobe Designerl 7.0 |
5.REMARKS (Continued)
DD FORM 2475,
"DOD EDUCATIONAL LOAN REPAYMENT PROGRAM (LRP) ANNUAL APPLICATION"
INSTRUCTIONS
SECTION 1. PERSONNEL OFFICE VERIFICATION (To be completed by the designated personnel officer.)
1.a. - b.
SECTION 2. SERVICEMEMBER DATA (To be completed by servicemember.)
2.a. - e.
2.f. Enter the total amount of money that has been paid by the military under the Loan Repayment Program on your education loans.
2.g. - h.
SECTION 3. LOAN DATA
(To be completed by servicemember.)
3.a. Name as it appears on the promissory note. 3.b. - c.
3.d. Loan ___ of ___ Loans. A separate DD Form 2475 must be completed for each loan if Servicemember has more than one (1) loan. For example, loan 1 of 3 loans, loan 2 of 3 loans, and loan 3 of 3 loans.
3.e. Loan Account Number of the current loan holder (usually found on payment book or coupon or on promissory note).
3.f. - h. Identify the name, address, and telephone number of the institution that currently holds your loan. Please list any additional contact information in Section 5, Remarks.
SECTION 4. LENDER VERIFICATION (To be completed by loan holder.)
4.a. Mark X in the appropriate box. 4.b.
4.c. Principal plus interest, plus any fees. Please specifically list the fees in Section 5, Remarks.
4.d.
4.e. Complete this block only if different than the one listed in 3.f. and 3.g.
4.f. Loan holder must provide their Federal tax identification number for tax withholding.
4.g. Type of Loan. Select from list below: The loan must qualify under the Higher Education Act of 1965, Title 4, Parts B and E; the Health Education Assistance Loan under Part C, Title VII, Public Health Service Act; under Part B, Title VIII; Health Professional Loans that the SECDEF determines to be critical to meet wartime medical skill shortages; William D. Ford Federal Direct Loan; or any loan incurred for educational purposes made by a lender that is: (1) an agency or instrumentality of a State; (2) a financial or credit institution (including an insurance company) that is subject to examination and supervision by an agency or the United States or any State; or (3) from a pension fund or a
4.h. If multiple loans have been consolidated, mark (X) "Yes" or "No" indicating consolidating action.
4.i. - k.
After completion and signature, the personnel records custodian will forward this form to the address listed in Section 1, block A.
SECTION 5. REMARKS.
Use this section to enter additional information that will assist in processing this application.
DD FORM 2475 (BACK), NOV 2006