Transcription of fis Statement - Action Financial Services, Llc
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fis Statement - Action Financial Services, Llc
LOAN REHABILITATION: INCOME AND EXPENSE INFORMATION William D. Ford Federal Direct Loan (Direct Loan) Program / Federal Family Education Loan (FFEL) Program OMBNo. 1845-0120 form Approved Exp. Date 5/31/2020 RIE 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 Code and 20 1097. SECTION 1:BORROWER INFORMATION Please enter or correct the following information. Check this box if any of your information has changed. SSN Name Address City Telephone - Primary Telephone - Alternate Email (Optional) State Zip Code SECTION 2: HOUSEHOLD INCOMEAND REASONABLEAND NECESSARY MONTHLYEXPENSES You received this form because you asked to rehabilitate your defaulted loans but objected to the payment amount your loan holder calculated using the 15% formula (see Section 6).
SECTION 5: INSTRUCTIONS If you are not completing this form electronically, type or print using dark ink. Enter dates as month-day-year (mm-dd-
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