Discharge Application Form PDF Details

Embarking on the journey to dissolve educational loans or service obligations due to severe disability involves navigating the complexities of the Discharge Application form, known formally as the TPD-APP. This form plays a pivotal role for individuals seeking relief under the mantle of Total and Permanent Disability across various federal education assistance programs, including the William D. Ford Federal Direct Loan Program, Federal Family Education Loan Program, Federal Perkins Loan Program, and the TEACH Grant Program. It stands as the gateway for applicants to potentially liberate themselves from the financial burdens of loans or service obligations by establishing their status of total and permanent disability through comprehensive documentation. Eligibility criteria require documentation from the U.S. Department of Veterans Affairs, the Social Security Administration, or a detailed physician's certification. Moreover, the application underscores the importance of accurate and complete information to avoid delays or rejections and outlines post-discharge monitoring conditions, underlining the gravity of honesty in the application process. Tax implications, the possibility of reinstatement of financial obligations due to non-compliance during the monitoring period, and provisions to designate a representative emphasize the careful consideration necessary before and after submitting the application. Finally, the form provides specific guidance on where and how to submit the application, ensuring that applicants are well-informed of the steps involved in seeking discharge through this pathway.

QuestionAnswer
Form NameDischarge Application Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesstudent loan forgiveness for disability form, total and permanent disability discharge, closed school loan discharge application, application for discharge form

Form Preview Example

TPD-APP

DISCHARGE APPLICATION: TOTAL AND PERMANENT

OMB No. 1845-0065

Form Approved

DISABILITY

Exp. Date 09/ 30/ 2019

William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family

Education Loan (FFEL) Program / Federal Perkins Loan (Perkins Loan)

Program / TEACH Grant Program

This is an application for a total and permanent disability discharge of your Direct Loan, FFEL, and/ or Perkins Loan program loan(s), and/ or your Teacher Education Assistance for College and Higher Education (TEACH) Grant Program service obligation.

Throughout this application, the w ords “w e,” “us,” and “our” refer to the U.S. Department of Education.

Make sure that Section 2, Section 3, and (if required)

Section 4 include all requested information. Incomplete or inaccurate information may cause your application to be delayed or rejected.

To qualify for this discharge, you must submit documentation from one of the follow ing sources:

1.The U.S. Department of Veterans Affairs (VA) OR

2.The Social Security Administration (SSA) OR

3.A physician's certification in Section 4 of this form

Except for VA or SSA determinations described below , a disability determination by another federal or state agency does not qualify you for this discharge.

U.S. Department of Veterans Affairs Documentation

If you are a veteran w ho has been determined by the VA to be unemployable due to a service-connected disability, you may qualify for discharge by providing documentation from the VA show ing that you have received one of the follow ing tw o types of VA disability determinations:

1.A determination that you have a service-connected disability (or disabilities) that is 100% disabling.

2.A determination that you are totally disabled based on an individual unemployability rating.

You do not qualify for discharge based on a VA disability determination if your disability is not service-connected.

Social Security Administration Documentation

If you are eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you may qualify for discharge by providing a copy of your notice of aw ard or Benefits Planning Query (BPQY) from the SSA. You only qualify for a discharge based on this documentation if it show s that your next scheduled disability review w ill be 5 to 7 years or more from the date of your last SSA disability determination.

If you w ant to submit a BPQY but do not have one, contact the SSA office that issued your aw ard and request form SSA-2459. You may also request a BPQY by calling 1-800-772-1213 or by visiting w w w .ssa.gov.

If you are granted a discharge based on SSA documentation, w e w ill monitor your status during a 3-year monitoring period. Your discharged loans or TEACH Grant service obligation may be reinstated if you do not meet certain requirements, as explained in Section 6 of this form .

Physician Certification

You may qualify for discharge by having a physician complete Section 4 of this application. The physician must certify that you are unable to engage in any substantial gainful activity (see definition in Section 5) by reason of a medically determinable physical or mental impairment that:

1.Can be expected to result in death;

2.Has lasted for a continuous period of at least 60 months; or

3.Can be expected to last for a continuous period of at least 60 months.

If you are granted a discharge based on a physician's certification, w e w ill monitor your status during a 3-year monitoring period. Your discharged loans or TEACH Grant service obligation may be reinstated if you do not meet certain requirements, as explained in Section 6 of this form .

Important Tax Information

Loan amounts discharged due to total and permanent disability may be considered taxable income by the Internal Revenue Service (IRS). Contact the IRS for more information.

How to Designate Someone to Represent You

If you w ish to designate an individual or organization to represent you in matters related to your total and permanent disability discharge request, you must complete the Applicant Representative Designation: Total and Permanent Disability form . You may obtain this form from our Total and Permanent Disability Discharge Servicer (see below for contact information).

WHERE TO SEND YOUR COMPLETED APPLICATION AND DOCUMENTATION

U.S. Department of Education - TPD Servicing

P.O. Box 87130

Lincoln, NE 68501-7130

Fax: 303-696-5250

IF YOU NEED HELP COMPLETING THE APPLICATION

Phone: 1-888-303-7818 (TTY: dial 711, then phone no.)

Email: disabilityinformation@nelnet .com

Website: w w w .disabilitydischarge.com

Page 1 of 8

TPD-APP

DISCHARGE APPLICATION: TOTAL AND PERMANENT

OMB No. 1845-0065

Form Approved

DISABILITY

Exp. Date 09/30/2019

William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family

Education Loan (FFEL) Program / Federal Perkins Loan (Perkins Loan)

Program / TEACH Grant Program

WARNING: Any person w ho know ingly 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.

SECTION 1: APPLICANT INFORMATION

Please enter or correct the follow ing information.

Check this box if any of your information has changed.

SSN

Date of Birth

Name

Address

City

 

State

 

Zip Code

 

 

 

 

 

Telephone - Primary

Telephone - Alternate

Email (Optional)

SECTION 2: TOTAL AND PERMANENT DISABILITY INFORMATION

Carefully read the entire application. Type or print in dark ink. Sign and date the application in Section 3.

1.Are you a veteran w ho has received a determination from the U.S. Department of Veterans Affairs (VA) that you are unemployable due to a service-connected

disability?

Yes - Attach documentation of the VA determination and complete Section 3. You do not need to have a

physician complete Section 4. No - Continue to Item 2.

2.Are you currently receiving SSDI or SSI benefits, and does your most recent notice of aw ard of Benefits Planning Query (BPQY) from the SSA state that your next scheduled disability review will be 5 to 7 years or more from the date of your last SSA disability determination?

Yes - Attach a copy of your most recent SSA notice of aw ard or BPQY and complete Section 3. You do not

need to have a physician complete Section 4. No - Complete Section 3 and have a physician

complete and sign Section 4.

SECTION 3: APPLICANT'S REQUEST, AUTHORIZATION, UNDERSTANDINGS, AND CERTIFICATIONS

I request that the U.S. Department of Education discharge my Direct Loan, FFEL, and/ or Perkins Loan program loan(s), and/ or my TEACH Grant service obligation.

I authorize any physician, hospital, or other institution having records about the disability that is the basis for my request for a discharge to make information from those records available to the U.S. Department of Education.

I understand that:

1.If I am applying for a discharge based on a physician's certification in Section 4, I must submit this application to the

U.S. Department of Education within 90 days of the date of my physician's signature in Section 4.

2.If I am a veteran w ho answ ered No to Item 1 in Section 2, and I obtained a certification from a physician in Section 4, that certification is only for purposes of determining my eligibility for a discharge of my loan(s) or TEACH Grant service obligation, and is not for purposes of determining my eligibility for, or the extent of my eligibility for, VA benefits.

I certify that: (1) I have a total and permanent disability, as defined in Section 5; and (2) I have read and understand the information in Sections 6 and 7.

 

 

 

 

Representative Name (if applicable)

Applicant's or Representative's Signature

 

Date

 

 

 

NOTE: You may designate someone to represent you in matters related to your application. If you w ish to designate a

representative, you must complete the Applicant Representative Designation: Total and Permanent Disability form .

Page 2 of 8

Applicant Name

 

Applicant SSN

 

 

 

SECTION 4: PHYSICIAN'S CERTIFICATION

Print legibly and initial any changes. Return the form to the applicant or representative.

Applicant Identification

1.Provide the below information regarding the individual for w hom you are completing this Section:

Name

Date of Birth

Medically Determinable Physical or Mental Impairment

2.Does the applicant have a medically determinable physical or mental impairment that prevents the applicant from engaging in any substantial gainful activity?

Substantial gainful activity means a level of w ork performed for pay or profit that involves doing significant physical or mental activities or a combination of both. If the applicant is able to engage in any substantial gainful activity in any field of w ork, you must answ er "No".

Yes - Continue to Item 3.

No - Do not complete this application.

Severity/Duration of Physical or Mental Impairment

3. Is the applicant's impairment expected to result in death? Yes - Skip to Item 5.

No - Continue to Item 4.

4.Has the applicant's impairment lasted or is it expected to last

for a continuous period of at least 60 months?

Yes - Continue to Item 5.

No - Do not complete this application.

Disabling Condition

Do not use insurance codes or abbreviations.

5.Provide your diagnosis of the applicant's impairment:

Physician's Certification

6.Describe the severity of the applicant's impairment, including, if applicable, the phase of the impairment:

Limitations

Explain how the condition prevents the applicant from engaging in any substantial gainful activity in any field of w ork. Attach additional pages if needed. Enter "N/ A" if not applicable. You may include additional information you believe is helpful in understanding the applicant's condition, such as medications or procedures used to treat the condition.

7.Limitations on sitting, standing, w alking, or lifting:

8.Limitations on activities of daily living:

9.Residual functionality:

10.Social/ behavioral limitations (if any):

11.Global Assessment Function Score (for psychiatric conditions):

I certify that, in my best professional judgment, the applicant identified in Item 1 has a medically determinable physical or mental impairment consistent w ith my responses in Items 2 through 10.

I understand that an applicant w ho is currently able to engage in any substantial gainful activity in any field of w ork does not have a total and permanent disability as defined on this form .

I am a doctor of:

medicine

osteopathy/ osteopathic medicine

State Where Legally Authorized to Practice*

 

Professional License Number (subject to verification; stamp is acceptable)

*If you are licensed to practice in American Samoa, Puerto Rico, the U.S. Virgin Islands, the Northern Mariana Islands, the Marshall Islands, Micronesia, or Palau, attach a copy of your professional license that clearly show s the expiration date.

 

 

 

Date (mm-dd-yyyy)

 

Physician Name (First, Middle, Last)

Physician's Signature (a stamp is not acceptable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone

 

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

Address (a stamp is acceptable)

 

 

 

 

 

 

 

 

 

 

 

 

Fax

 

 

 

Page 3 of 8

 

 

 

 

SECTION 5: DEFINITIONS

If you have a total and permanent disability, this means that: (1) you are unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment that can be expected to result in death, or that has lasted for a continuous period of not less than 60 months, or that can be expected to last for a continuous period of not less than 60 months; OR (2) you are a veteran w ho has been determined by the VA to be unemployable due to a service-connected disability. Except for certain individuals w ho have received SSA notices of aw ard for SSDI or SSI benefits, or for certain veterans, a disability determination by another federal or state agency does not establish your eligibility for a discharge of your loan(s) and/ or TEACH Grant service obligation due to a total and permanent disability.

Substantial gainful activity means a level of w ork performed for pay or profit that involves doing significant physical or mental activities, or a combination of both.

A discharge of a loan due to a total and permanent disability cancels your obligation (and, if applicable, an endorser's obligation) to repay the remaining balance on your Direct Loan, FFEL, and/ or Perkins Loan program loans. A discharge of a TEACH Grant service obligation cancels your obligation to complete the teaching service that you agreed to perform as a condition for receiving a TEACH Grant .

The post-discharge monitoring period begins on the date w e grant a discharge of your loan(s) or TEACH Grant service obligation and lasts for three years. If you fail to meet certain conditions at any time during or at the end of the post - discharge monitoring period, w e w ill reinstate your obligation to repay your loan(s) or complete your TEACH Grant service. See Section 6 for more information.

Note to Veterans: The post -discharge monitoring period does not apply if you are a veteran w ho receives a discharge based on a determination from the VA that you are unemployable due to a service-connected disability.

The William D. Ford Federal Direct Loan (Direct Loan)

Program includes Federal Direct Stafford/ Ford Loans (Direct Subsidized Loans), Federal Direct Unsubsidized Stafford/ Ford Loans (Direct Unsubsidized Loans), Federal Direct PLUS Loans (Direct PLUS Loans), and Federal Direct Consolidation Loans (Direct Consolidation Loans).

The Federal Family Education Loan (FFEL) Program includes Federal Stafford Loans (both subsidized and unsubsidized), Federal Supplemental Loans for Students (SLS), Federal PLUS Loans, and Federal Consolidation Loans.

The Federal Perkins Loan (Perkins Loan) Program includes Federal Perkins Loans, National Direct Student Loans (NDSL), and National Defense Student Loans (Defense Loans).

The Teacher Education Assistance for College and

Higher Education (TEACH) Grant Program requires individuals to complete a teaching service obligation as a condition for receiving a TEACH Grant .

The holder of your FFEL Program loan(s) may be a lender, a guaranty agency, or the U.S. Department of Education. The holder of your Perkins Loan Program loan(s) may be a school you attended or the U.S. Department of Education. The holder of your Direct Loan Program loan(s) and/ or your TEACH Grant Agreement to Serve (if you received a TEACH Grant) is the U.S. Department of Education. Your loan holder may use a servicer to handle billing and other matters related to your loan. The term “holder” as used on this application means either your loan holder or, if applicable, your loan servicer.

The term “state” for purposes of the physician's certification in Section 4 (the physician must be licensed to practice in a state) includes the 50 United States, the District of Columbia, American Samoa, the Commonw ealth of Puerto Rico, Guam, the U.S. Virgin Islands, the Commonw ealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau.

A representative is a member of your family, your attorney, a law firm or legal aid society, or another individual or organization authorized to act on your behalf in connection w ith your total and permanent disability discharge application.

SECTION 6: DISCHARGE PROCESS / ELIGIBILITY REQUIREMENTS / TERMS AND CONDITIONS FOR DISCHARGE

Applying for discharge (all applicants):

Submission of discharge application. After you submit your completed application and documentation to us, w e w ill send you a notice that w ill:

Acknow ledge receipt of your application;

Explain the process for our review of your application; and

Inform you that you are not required to make any payments on your loans w hile w e review your application for discharge.

Consequences of failure to submit an application. If you do not submit an application to us w ithin 120 days of notifying us that you intend to submit an application, collection activity w ill resume on your loans, and your loan holder may capitalize any unpaid interest . This means that the unpaid interest w ill be added to the principal balance of your loans, and interest w ill then be charged on the increased loan principal amount . How ever, if you have a FFEL Program loan and the loan holder is a guaranty agency, or if you have a Federal Perkins Loan, unpaid interest w ill not be capitalized.

Page 4 of 8

Page 5 of 8

SECTION 6: DISCHARGE PROCESS / ELIGIBILITY REQUIREMENTS / TERMS AND CONDITIONS FOR DISCHARGE (CTD.)

Discharge process for veterans who have been determined by the VA to be unemployable due to a service-connected disability:

Our review of your discharge application. We w ill review the documentation from the VA to determine if you are totally and permanently disabled as described in item (2) of the definition of “total and permanent disability” in Section 5 of this application.

Determination of eligibility or ineligibility for

discharge. If w e determine that you are totally and permanently disabled, you w ill be notified that your loans and/ or TEACH Grant service obligation has been discharged. The discharge w ill be reported to nationw ide consumer reporting agencies, and any loan payments received on your loan on or after the effective date of the determination by the VA that you are unemployable due to a service- connected disability w ill be refunded to the person w ho made the payments.

If w e determine that you are not totally and permanently disabled, you w ill be notified of that determination. The notification w ill include:

The reason or reasons for the denial of your discharge application;

An explanation that your loans are due and payable to the loan holder under the terms of the promissory note that you signed and that your loans w ill return to the status they w ere in at the time you applied for a total and permanent disability discharge;

An explanation that your loan holder w ill notify you of the date you must resume making payments on your loans; and

An explanation that if you applied for a discharge of a TEACH Grant service obligation, you must comply

w ith all terms and conditions of your TEACH Grant Agreement to Serve.

The notification w ill also explain your ability to request reconsideration of this determination or to submit a new discharge application:

You may request that w e re-evaluate your discharge application by providing additional documentation from the VA that supports your eligibility for discharge. If you provide this documentation w ithin 12 months of the date of our notification that you are ineligible for discharge, you do not have to submit a new application. After 12 months, a new application is required.

If the documentation from the VA does not indicate that you are unemployable due to a service- connected disability, you may reapply for discharge under the “Discharge Process For All Other Applicants”. You must submit a new application w ith the required documentation from the SSA or a physician's certification in Section 4.

Discharge process for all other applicants:

Our review of your discharge application. If you submit a discharge application supported by an aw ard of benefits notice from the SSA or an SSA Benefits Planning Query (BPQY), w e w ill review that documentation to determine if it meets the requirements described in Section 2, Item 2 of this form .

If you submit a discharge application supported by a physician's certification in Section 4 of this application, w e w ill review the physician's certification and any accompanying documentation to determine if you are totally and permanently disabled as described in item (1) of the definition of “total and permanent disability” in Section 5 of this application. We may also contact your physician for additional information, or may arrange for an additional review of your condition by an independent physician at our expense. Based on the results of this review , w e w ill determine your eligibility for discharge.

If w e determine during our review of your application that you received a Direct Loan or Perkins Loan program loan, or a TEACH Grant before the date w e received the SSA notice of aw ard (or BPQY) or before the date the physician certified your application in Section 4, and a disbursement of that loan or grant is made after that date, but before w e have granted a discharge, w e w ill suspend processing of your discharge request until you ensure that the full amount of the disbursement is returned to the loan holder or (for a TEACH Grant) to us.

If you apply for a total and permanent disability discharge and w e determine as part of our review that a new Direct Loan or Perkins Loan program loan or a new TEACH Grant w as made to you on or after the date w e received the SSA notice of aw ard (or BPQY) or the date the physician certified your application in Section 4, and before the date w e grant a discharge, w e w ill deny your discharge request . Collection w ill resume on your loans and you w ill again be responsible for complying w ith the terms and conditions of your TEACH Grant Agreement to Serve.

Determination of eligibility or ineligibility for

discharge. If w e determine that you are totally and permanently disabled, w e w ill notify you that a discharge has been approved, and that you w ill be subject to a post - discharge monitoring period for three years beginning on the discharge date. The notification of discharge w ill explain the terms and conditions under w hich w e w ill reinstate your obligation to repay your loan or to complete your TEACH service. The discharge w ill be reported to nationw ide consumer reporting agencies, and any loan payments that w ere received after the date w e received the SSA notice of aw ard (or BPQY) or after the date the physician certified your discharge application w ill be returned to the person w ho made the payments.

SECTION 6: DISCHARGE PROCESS / ELIGIBILITY REQUIREMENTS / TERMS AND CONDITIONS FOR DISCHARGE (CTD.)

Discharge process for all other applicants (continued):

Determination of eligibility or ineligibility for discharge (continued).

If w e determine that you are not totally and permanently disabled, you w ill be notified of that determination. The notification w ill include:

The reason or reasons for the denial of your discharge application;

An explanation that your loans are due and payable to the loan holder under the terms of the promissory note that you signed and that your loans w ill return to the status that w ould have existed if your total and permanent disability discharge application had not been received;

An explanation that your loan holder w ill notify you of the date you must resume making payments on your loans;

An explanation that if you applied for a discharge of a TEACH Grant service obligation, you must comply

w ith all terms and conditions of your TEACH Grant Agreement to Serve;

An explanation that you are not required to submit a new total and permanent disability discharge application if, w ithin 12 months of the date of our notification to you that you are ineligible for discharge, you provide additional information regarding your disabling condition that supports your eligibility for discharge, and you request that w e re-evaluate your discharge application; and

An explanation that if you do not request re- evaluation of your prior discharge application w ithin 12 months of the date of our notification of ineligibility for discharge, and you still w ish to have us re-evaluate your eligibility for a total and permanent disability discharge, you must submit a new total and permanent disability discharge application to us.

If you request a re-evaluation of your total and permanent disability discharge application or submit a new total and permanent disability discharge application, as described above, your request must include new information regarding your disabling condition that w as not provided to us in connection w ith your prior application for discharge.

Post-discharge monitoring period. If you are granted a discharge, w e w ill monitor your status during the 3-year post -discharge monitoring period that begins on the date the discharge is granted.

We w ill reinstate the requirement for you to repay your loans and/ or complete your TEACH Grant service if, at any time during or at the end of the post -discharge monitoring period, you:

Receive annual earnings from employment that exceed the poverty guideline amount (see Note below ) for a family of tw o in your state, regardless of your actual family size;

Receive a new loan under the Direct Loan Program or the Perkins Loan Program, or a new TEACH Grant;

Receive a disbursement of a Direct Loan Program or Perkins Loan Program loan or a TEACH Grant that w as initially disbursed prior to your discharge date and you fail to ensure that the disbursement is returned to the loan holder or (for a TEACH Grant) to us w ithin 120 days of the disbursement date; or

Receive a notice from the SSA indicating that you are no longer disabled or that your continuing disability review w ill no longer be the 5- to 7-year period indicated in the SSA notice of aw ard or BPQY.

During the 3-year post -discharge monitoring period, you (or your representative) must:

Promptly notify us of any changes in your address or telephone number;

Promptly notify us if your annual earnings from employment exceed the poverty guideline amount for a family of tw o in your state (see Note below ), regardless of your actual family size;

Upon request, provide us w ith documentation of your annual earnings from employment, on a form that w e w ill provide; and

Promptly notify us if you receive a notice from the SSA indicating that you are no longer disabled or that your continuing disability review w ill no longer be the 5- to 7-year period indicated in the SSA notice of aw ard or BPQY (after you had been previously determined to be disabled by the SSA, w ere receiving SSDI or SSI benefits, and had a continuing disability review period of 5 to 7 years or more from the date of your last SSA disability determination).

Note: The poverty guideline amounts are updated annually and may be obtained at http://aspe.hhs.gov/ poverty. We w ill notify you of the current poverty guideline amounts during each year of the post -discharge monitoring period.

Page 6 of 8

SECTION 6: DISCHARGE PROCESS / ELIGIBILITY REQUIREMENTS / TERMS AND CONDITIONS FOR DISCHARGE (CTD.)

Discharge process for all other applicants (continued):

Reinstatement of obligation to repay discharged loans or complete discharged TEACH Grant service obligation. If you do not meet the requirements described above at any time during or at the end of the post -discharge monitoring period, w e w ill reinstate your obligation to repay your loans and/ or to complete your TEACH Grant service. If your loans are reinstated, you w ill be responsible for repaying your loans to us in accordance w ith the terms of your promissory note(s). Your loans w ill be returned to the status that w ould have existed if w e had not received your total and permanent disability discharge application.

How ever, you w ill not be required to pay interest on your loans for the period from the date of the discharge until the date your repayment obligation w as reinstated. We w ill be your loan holder. If your TEACH Grant service obligation is reinstated, you w ill again be subject to the requirements of your TEACH Grant Agreement to Serve. If you do not meet the terms of that agreement and the TEACH Grant funds you received are converted to a Direct Unsubsidized Loan, you must repay that loan in full, and interest w ill be charged from the date(s) that the TEACH Grant funds w ere disbursed.

If your obligation to repay your loans or to complete your TEACH Grant service is reinstated, w e w ill notify you of the reinstatement . This notification w ill include:

The reason or reasons for the reinstatement;

For loans, an explanation that the first payment due date on the loan follow ing the reinstatement w ill be no earlier than 60 days follow ing the date of the notification of reinstatement; and

Information on how you may contact us if you have questions about the reinstatement, or if you believe that your obligation to repay a loan or complete TEACH Grant service w as reinstated based on incorrect information.

SECTION 7: ELIGIBILITY REQUIREMENTS TO RECEIVE FUTURE LOANS OR TEACH GRANTS

For veterans who receive a total and permanent disability discharge based on a determination by the VA that they are unemployable due to a service-connected disability:

If you are a veteran w ho is granted a discharge based on a determination that you are totally and permanently disabled as described in item (2) of the definition of “total and permanent disability” in Section 5 of this application, you are not eligible to receive future loans under the Direct Loan Program or the Perkins Loan Program, or future TEACH Grants, unless:

You obtain a certification from a physician that you are able to engage in substantial gainful activity; and

You sign a statement acknow ledging that the new loan or TEACH Grant service obligation cannot be discharged in the future on the basis of any injury or illness present at the time the new loan or TEACH Grant is made, unless your condition substantially deteriorates so that you are again totally and permanently disabled.

For all other individuals who receive a total and permanent disability discharge:

If you are granted a discharge based on a determination that you are totally and permanently disabled in accordance w ith item (1) of the definition of “total and permanent disability” in Section 5 of this application, you are not eligible to receive future loans under the Direct Loan Program or the Perkins Loan Program, or future TEACH Grants, unless:

You obtain a certification from a physician that you are able to engage in substantial gainful activity;

You sign a statement acknow ledging that the new loan or TEACH Grant service obligation cannot be discharged in the future on the basis of any injury or illness present at the time the new loan or TEACH Grant is made, unless your condition substantially deteriorates so that you are again totally and permanently disabled; and

If you request a Direct Loan Program or Perkins Loan Program loan, or a new TEACH Grant, w ithin three years of the date that a previous loan or TEACH Grant w as discharged, you resume payment on the previously discharged loan or acknow ledge that you are once again subject to the terms of the TEACH Grant Agreement to Serve before receiving the new loan.

Page 7 of 8

SECTION 8: WHERE TO SEND THE COMPLETED DISCHARGE APPLICATION

Return the completed form and any documentation to:

If you need help completing this form, contact us:

U.S. Department of Education - TPD Servicing

Phone: 1-888-303-7818 (TTY: dial 771, then phone no.)

P.O. Box 87130

Email: disabilityinformation@nelnet .com

Lincoln, NE 68501-7130

Website: w w w .disabilitydischarge.com

Fax to: 303-696-5250

 

Email to: disabilityinformation@nelnet .com

 

 

SECTION 9: IMPORTANT NOTICES

 

 

 

Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C.

To assist program administrators w ith tracking refunds

552a) requires that the follow ing notice be provided to you:

and cancellations, disclosures may be made to guaranty

The authorities for collecting the requested information

agencies, to financial and educational institutions, or to

federal or state agencies. To provide a standardized method

from and about you are §421 et seq., §451 et seq., §461, or

for educational institutions to efficiently submit student

§420L of the Higher Education Act of 1965, as amended (20

enrollment statuses, disclosures may be made to guaranty

U.S.C. 1071 et seq., 20 U.S.C. 1087a et seq., 20 U.S.C. 1087aa

agencies or to financial and educational institutions. To

et seq., or 20 U.S.C. 1070g et seq.) and the authorities for

counsel you in repayment efforts, disclosures may be made

collecting and using your Social Security Number (SSN) are

to guaranty agencies, to financial and educational

§§428B(f) and 484(a)(4) of the HEA (20 U.S.C. 1078-2(f) and

institutions, or to federal, state, or local agencies.

1091(a)(4)) and 31 U.S.C. 7701(b). Participating in the Direct

 

Loan,FFEL, Perkins Loan, or TEACH Grant program and

In the event of litigation, w e may send records to the

giving us your SSN are voluntary, but you must provide the

Department of Justice, a court, adjudicative body, counsel,

requested information, including your SSN, to participate.

party, or w itness if the disclosure is relevant and necessary

The principal purposes for collecting the information on

to the litigation. If this information, either alone or w ith

other information, indicates a potential violation of law , w e

this form, including your SSN, are to verify your identity, to

may send it to the appropriate authority for action. We may

determine your eligibility to receive a loan or a benefit on a

send information to members of Congress if you ask them

loan (such as a deferment, forbearance, discharge, or

to help you w ith federal student aid questions. In

forgiveness) under the Direct Loan, FFEL, Federal Perkins

circumstances involving employment complaints,

Loan or TEACH Grant Programs, to permit the servicing of

grievances, or disciplinary actions, w e may disclose relevant

your loans, and, if it becomes necessary, to locate you and

records to adjudicate or investigate the issues. If provided

to collect and report on your loans if your loans become

for by a collective bargaining agreement, w e may disclose

delinquent or default . We also use your SSN as an account

records to a labor organization recognized under 5 U.S.C.

identifier and to permit you to access your account

Chapter 71. Disclosures may be made to our contractors for

information electronically.

the purpose of performing any programmatic function that

The information in your file may be disclosed, on a case-

requires disclosure of records. Before making any such

by-case basis or under a computer matching program, to

disclosure, w e w ill require the contractor to maintain Privacy

third parties as authorized under routine uses in the

Act safeguards. Disclosures may also be made to qualified

appropriate systems of records notices. The routine uses of

researchers under Privacy Act safeguards.

this information include, but are not limited to, its disclosure

Paperwork Reduction Notice. According to the

to federal, state, or local agencies, to private parties such as

Paperw ork Reduction Act of 1995, no persons are required

relatives, present and former employers, business and

to respond to a collection of information unless such

personal associates, to consumer reporting agencies, to

collection displays a valid OMB control number. The valid

financial and educational institutions, and to guaranty

OMB control number for this information collection is

agencies in order to verify your identity, to determine your

1845-0065. Public reporting burden for this collection of

eligibility to receive a loan or a benefit on a loan, to permit

information is estimated to average 30 minutes per

the servicing or collection of your loans, to enforce the

response, including time for review ing instructions,

terms of the loans, to investigate possible fraud and to verify

searching existing data sources, gathering and maintaining

compliance w ith federal student financial aid program

the data needed, and completing and review ing the

regulations, or to locate you if you become delinquent in

collection of information. The obligation to respond to this

your loan payments or if you default . To provide default rate

collection is required to obtain a benefit in accordance w ith

calculations, disclosures may be made to guaranty agencies,

34 CFR 674.61(b) or (c), 34 CFR 682.402(c)(2) or (c)(9), 34 CFR

to financial and educational institutions, or to state

685.213(b) or (c), and 34 CFR 686.42(b). If you have

agencies. To provide financial aid history information,

comments or concerns regarding the status of your

disclosures may be made to educational institutions.

individual submission of this form, please contact the U.S.

 

 

Department of Education directly (see Section 6).

Page 8 of 8

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How one can fill out total and permanent disability discharge step 1

2. Right after this section is completed, go on to enter the applicable details in all these - Please enter or correct the, Check this box if any of your, SSN, Date of Birth, Name, Address, City, Telephone Primary, Telephone Alternate, Email Optional, State, Zip Code, SECTION TOTAL AND PERMANENT, Carefully read the entire, and Are you a veteran who has.

Telephone  Alternate, Name, and Date of Birth inside total and permanent disability discharge

3. Completing Yes Attach documentation of the, does your most recent notice of, Yes Attach a copy of your most, SECTION APPLICANTS REQUEST, I request that the US Department, If I am applying for a discharge, I certify that I have a total and, Applicants or Representatives, Date, Representative Name if applicable, and NOTE You may designate someone to is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

SECTION  APPLICANTS REQUEST, I certify that  I have a total and, and I request that the US Department inside total and permanent disability discharge

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