APPENDIX A
SAMPLE STUDENT LOAN REPAYMENT AGREEMENT
DEPARTMENT OF THE INTERIOR
STUDENT LOAN REPAYMENT SERVICE AGREEMENT
Title 5 U.S.C. 5379 allows repayment of outstanding federally insured
or guaranteed student loans made by educational institutions or banks and
other private lenders as authorized by the Higher Education Act of 1965
and the Public Health Service Act, as defined in 5 CFR 537.102. Student
loan repayments are made directly to the lender subject to the conditions
stated in this agreement. Use of this authority in no way constitutes a
right, promise, or entitlement for continued employment or noncompetitive
conversion to the competitive service.
CONDITIONS OF EMPLOYMENT
___________(BUREAU)___________________ agrees to provide a student loan
repayment benefit to:
| EMPLOYEE |
SOCIAL SECURITY NUMBER |
POSITION |
| |
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subject to the conditions of employment stated in this document
(STATE CONDITIONS OF EMPLOYMENT SPECIFIC TO EACH AGREEMENT AS DESCRIBED
IN 5 CFR 537.107(a) HERE OR ATTACH AS SEPARATE PAGE.)
CONDITIONS OF LOAN REPAYMENT
I agree to complete _______(MINIMUM OF THREE YEARS SERVICE)_____ for
the ____(BUREAU)___. My period of service begins when ____(BUREAU)____
makes the first payment to:
(LENDER NAME AND FULL ADDRESS)
In return, ______(BUREAU)_______, though its payroll provider, will
make payments on my outstanding federally insured or guaranteed loan under
the following terms. Increases or renewals made under this part, not to
exceed $6000 each calendar year up to a lifetime total of $40,000, (may/may
not) be made without requiring a new service agreement.
| REPAYMENT AMOUNT |
YEARS |
TOTAL |
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LOAN REPAYMENT PROCEDURES
The National Business Center's Payroll Operations Division will make
payments to ____(LENDER)____ on an annual basis. The Payroll Operations
Division will disburse the net of the repayment amount to the loan holder.
Income and employment taxes will be withheld from the gross amount of the
loan repayment amount. I understand that my W-2 Form will show the gross
amount of the repayment as wages and that taxes and other assessments,
deducted from the gross amount, will be shown in their appropriate categories
on the W-2 Form. Payments to lenders will be in the form determined by
the Payroll Operations Division. The Department of Interior is not responsible
for any late fees or penalties assessed by the loan holder(s) prior, during,
or subsequent to this agreement.
TERMINATION AND REIMBURSEMENT OF LOAN REPAYMENT BENEFIT
I understand I will no longer be eligible for the loan repayment incentive
if I voluntarily end my employment with DOI, am separated for reasons of
misconduct or performance, fail to maintain an acceptable level of performance,
or in any way violate the terms of this agreement. Further, I understand
that if my employment with the Department of the Interior terminates, for
the aforementioned reasons,(indicate as appropriate: "except" or "including")
when I leave DOI to accept employment in another federal agency, before
I have completed the period of service specified in this agreement, I will
be indebted to the DOI.
CONTINUED EMPLOYEE LOAN REPAYMENT RESPONSIBILITY
I understand that it is my responsibility, and I agree, to make loan
payments on the portion of the loan(s) that continues to be my responsibility.
I understand that my failure to continue to make these loan payments violates
this agreement and terminates my eligibility for further loan repayment
benefits.
I CERTIFY THAT I HAVE DISCUSSED THE CONDITIONS OF THE STUDENT LOAN REPAYMENT
PROGRAM WITH THE HUMAN RESOURCES OFFICE REPRESENTATIVE. I AGREE THAT, IF
I FAIL TO COMPLETE THE PRESCRIBED PERIOD OF SERVICE UNDER THE TERMS OF
THE SERVICE AGREEMENT, WITH THE DEPARTMENT OF THE INTERIOR, I WILL REIMBURSE
THE ______(BUREAU)____ FOR THE ENTIRE AMOUNT OF ALL LOAN REPAYMENTS (GROSS,
BEFORE TAXES, AND DEDUCTIONS) THE _____(BUREAU)____ MADE ON MY BEHALF UNDER
THIS AGREEMENT.
_________________________________________ ________________
EMPLOYEE SIGNATURE
DATE
_________________________________________ ________________
HRO REPRESENTATIVE SIGNATURE
DATE
"This information is subject to the Privacy Act of 1974, as amended."
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