Fillable 1314DVFNH Electronic Form Distributed (Orange County Community College)

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1314DVFNH Electronic Form Distributed (Orange County Community College)

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DVFNH 1314 DEPENDENT VERIFICATION FORM (V1 or V5)
Your 2013 -2014 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called Verification. The law says before
awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you provided correct information
the financial aid administrator at your school will compare your FAFSA with the information on this worksheet and with any other required documents. If
there are differences, your FAFSA information may need to be corrected. You must complete and sign this worksheet, attach any required documents,
and submit the form and other required documents to the financial aid administrator at your school. Your school may ask for additional information. If you
have questions about verification, contact your financial aid administrator as soon as possible so your financial aid will not be delayed.
A. STUDENT INFORMATION
ID # (MUST start with A)
First Name MI Last Name
Phone Format: XXXXXXXXXX E-mail
B. NON-TAXABLE INCOME INFORMATION TO BE VERIFIED
If yes, I certify that I paid child support in 2012. I have listed below the names of the persons to whom the child support was paid, the names of the
children for whom the child support was paid and the total amount of child support paid in 2012 for each child. I also attest that I have not included these
children as members of my household size. (Parents can either include these children as members of the household *or* include the amount of child
support paid but may not include these children as members of the household and also list child support paid.
Name who paid the child support Name who received the support For whom support was paid Yearly amount paid
Did the parent (and, if married, the parent's spouse) pay child support in 2012? (See drop down menu for options)
Did someone in the household (listed in Section B) receive benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as
food stamps) any time during the 2011 or 2012 calendar years? (
See drop down menu for options)
SSN Format: XXXXXXXXX
Date of Birth
C. DEPENDENT STUDENT'S TAX INFORMATION TO BE VERIFIED
Did you file / will file a 2012 tax return? (See drop down menu for options)
IMPORTANT INFORMATION: If you filed, or will file, an amended 2012 IRS tax return, you must contact your financial aid administrator before
completing this section.
The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA online. If you have not already used the tool, go to FAFSA.
gov, log in to your FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there, follow the
instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2012 IRS income tax information into your FAFSA. It takes up to
two weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to eight weeks for paper
IRS tax return filers. If you need more information about when, or how to use the IRS Data Retrieval Tool see your financial aid administrator.
I, the student.... (See drop down menu for options)
Complete the section below ONLY if you were employed in 2012 AND DID NOT file a 2012 tax return.
You MUST provide documentation of all monies earned (e.g. copy of W-2).
Employer's Name Total Amount Earned in 2012 Received a W-2
D. DEPENDENT PARENT'S TAX INFORMATION TO BE VERIFIED
IMPORTANT INFORMATION: If the parent (and, if married, the parent's spouse) filed, or will file, an amended 2012 IRS tax return, you must contact
your financial aid administrator before completing this section.
The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA online. If you have not already used the tool, go to FAFSA.
gov, log in to your FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there, follow the
instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2012 IRS income tax information into your FAFSA. It takes up to
two weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to eight weeks for paper
IRS tax return filers. If you need more information about when, or how to use the IRS Data Retrieval Tool see your financial aid administrator.
Did the parent (and if married, the parent's spouse) file / will file a 2012 tax return? (See drop down menu for options)
I, the parent (and, if married, the parent's spouse).... (See drop down menu for options)
E. CERTIFICATIONS
Electronic Certification Agreement. By providing your full student ID # below and by selecting the "I Accept" button, you consent that all of the
information reported is complete and correct. You further agree that you will submit a Dependent Verification Worksheet Affidavit Signature Form, with
original signatures of BOTH the student and parent, for verification purposes.
WARNING: If you purposely give false or misleading information on the worksheet, you may be
fined, be sentenced to jail, or both.
I Accept
ID # (MUST start with A)
Student's Full Name
To electronically submit this form you MUST use the "SUBMIT" button located at the top of this form.
You MUST have Adobe Reader 9 or higher to submit this form electronically.
If you DO NOT see a submit button in the top right of this form you will need to
To verify your form was properly submitted, allow 48 hours then check your "Financial Aid Status" in your Banner Self Service account.
Complete the section below ONLY if the parent (and, if married, the parent's spouse) were employed in 2012 AND DID NOT file a 2012 tax return.
You MUST provide documentation of all monies earned (e.g. copy of W-2).
Employer's Name Total Amount Earned in 2012 Received a W-2
Student Certification:
You MUST submit a Dependent Verification Worksheet Affidavit Signature Form, with original signatures of BOTH the
student and parent, before your financial aid can be finalized. (http://www.sunyorange.edu/financialaid/forms/docs/1213AFFIDAVITDVF_000.pdf)
Parent Certification:
I Accept
Parent's Full Name
Office Use Only
Submitted Notified N/A Submitted Notified N/A
SNAP SW2
Initials: CSP MW2
STT FW2
PTT DAVD
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1314DVFNH Electronic Form Distributed (Orange County Community College)

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Completed 20 July 2020

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