Discharge Application: Total and Permanent Disability at a glance
What it is: The Discharge Application: Total and Permanent Disability is an application for a TPD discharge of federal student loans or a TEACH Grant service obligation.
Who signs: Sign and date the application in Section 5: Applicant's or Representative's Signature, Date.
To qualify for TPD discharge, you must have a total and permanent disability.
You are considered to have a total and permanent disability if you are a veteran who has been determined by the U.S. Department of Veterans Affairs to be unemployable due to a service-connected disability. You are considered to have a total and permanent disability if you are unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment. The impairment can be expected to result in death, or has lasted for a continuous period of not less than 60 months, or can be expected to last for a continuous period of not less than 60 months.
A filled-in Discharge Application: Total and Permanent Disability example: a nurse practitioner certifies the disability
How to fill out Discharge Application: Total and Permanent Disability, box by box
Section 3: Applicant Information
Section 3: Applicant Information. Please enter or correct the following information: Social Security Number (SSN), Date of Birth, Name, Address, City, State, Zip Code, Phone - Primary, Phone - Alternate, Email.
Check this box if any of your information has changed.
Section 4, Question 1: VA determination
Are you a veteran who has received a determination from the U.S. Department of Veterans Affairs (VA) that (A) you have a service-connected disability (or disabilities) that is 100% disabling, or (B) you are totally disabled based on an individual unemployability rating?
Yes - Attach documentation of the VA determination and complete Section 5. Send pages 3 and 4 with the required VA documentation to the address shown in Section 1.
No - Continue to Question 2.
Section 4: Are you currently receiving SSDI or SSI benefits, or SSA retirement benefits
A. You qualify for SSDI or SSI based on disability, and your next scheduled disability review is between 5 and 7 years from the date of your last SSA disability determination.
B. You qualify for SSDI or SSI based on disability and your next continuing disability review has been scheduled at 3 years.
C. You have an established onset date for SSDI or SSI of at least 5 years before the date of your application for TPD discharge, or you have been receiving SSDI or SSI based on disability for at least 5 years before the date of your application for TPD discharge.
D. You qualify for SSDI or SSI based on a compassionate allowance.
E. You are currently receiving SSA retirement benefits, and before you qualified for SSA retirement benefits, you met one of the requirements described in paragraphs A through D.
Yes - Attach a copy of your most recent SSA notice of award or BPQY, or other documentation showing that you meet one of the requirements listed and complete Section 5. Send pages 3 and 4 with the required SSA documentation to the address shown in Section 1.
If you submit documentation other than a notice of award or BPQY, it will be accepted only if it provides sufficient information to determine that you meet the requirements.
No - Complete Section 5 and have an authorized medical professional complete and sign Section 6. Send pages 3 through 9 to the address shown in Section 1.
Section 5: Applicant's or Representative's Signature, Date
If you are applying for a discharge based on an authorized medical professional's certification in Section 6, you must submit this application to the U.S. Department of Education within 90 days of the date of the authorized medical professional's signature in Section 6.
Representative Name (if applicable): You may designate someone to represent you in matters related to your application. If you wish to designate a representative, you must complete the Applicant Representative Designation: Total and Permanent Disability form.
You certify that you have a total and permanent disability, as defined in Section 3. You certify that, if you are a veteran applying for TPD discharge based on a qualifying VA disability determination, you have read and understand the information in Section 8. You certify that, if you are applying for TPD discharge based on a qualifying SSA disability determination or a certification from an authorized medical professional, you have read and understand the information in Section 9.
Provide the name and date of birth of the applicant
Have an authorized medical professional complete and sign Section 6. To complete this section of the application, you must be one of the following: A doctor of medicine or doctor of osteopathy legally authorized to practice in a state; A nurse practitioner licensed by a state; A physician assistant licensed by a state; or A certified psychologist at the independent practice level who is licensed to practice in the United States.
Provide the name and date of birth of the applicant.
Does the applicant have a medically determinable physical or mental impairment
Does the applicant have a medically determinable physical or mental impairment that prevents the applicant from engaging in any substantial gainful activity? If the applicant is able to engage in any substantial gainful activity in any field of work, you must answer "No." Yes - Continue to Item 3. No - Do not complete this application.
Is the applicant's impairment expected to result in death? Yes - Skip to Item 5. No - Continue to Item 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.
Provide your diagnosis of the applicant's impairment
Provide your diagnosis of the applicant's impairment (do not use insurance codes or abbreviations). Describe the severity of the applicant's impairment, including, if applicable, the phase of the impairment.
Explain in Items 7 through 11
Explain in Items 7 through 11 how the condition prevents the applicant from engaging in any substantial gainful activity in any field of work. 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, walking, 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).
State Where Legally Authorized to Practice or Licensed
State Where Legally Authorized to Practice or Licensed. 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 shows the expiration date.
Professional License Number (subject to verification; stamp is acceptable).
Signature (a stamp is not acceptable), Date(mm-dd-yyyy), Name (First, Middle, Last), Address (a stamp is acceptable), Email, Telephone, Fax.
More rules for Discharge Application: Total and Permanent Disability
Make sure that all requested information is included. If your application is incomplete, it may be rejected, or the processing of your application may be delayed.
If your situation is different
You plan to apply for TPD discharge
Contact ED or its TPD Discharge Servicer as soon as you know that you plan to apply for TPD discharge. To give you time to complete your application, ED will then instruct your federal student loan holders to stop requiring you to make loan payments for up to 120 days.
Before you go
To show that you have a total and permanent disability, you must submit certain documentation from the U.S. Department of Veterans Affairs (VA), the Social Security Administration (SSA), or certain licensed or certified medical professionals.
If you qualify for TPD discharge by providing documentation from the VA or the SSA, you are not required to have a medical professional complete Section 6 of this application.
Please omit pages 10-19 when mailing or faxing back.
Common questions about Discharge Application: Total and Permanent Disability
Where do I file it?
Return the completed form and any documentation to U.S. Department of Education - TPD Servicing P.O. Box 300010 Greenville, TX 75403 Fax: 540-212-2415.
Is there a penalty?
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.
When is this form not the right one?
Except for VA or SSA determinations as described in Sections 8 and 9, a disability determination by another federal or state agency does not qualify you for this discharge.
Sources
[1] Discharge Application: Total and Permanent Disability (OMB No. 1845-0065), Federal Student Aid, U.S. Department of Education (the Official source link on this page).