Student Name _____________________________________________ Student ID or SSN _________________________
2018–2019 Verification of 2016 Income Information for Parent Nontax Filers
Please return this completed form and all other required materials to:
Ottumwa Campus: Indian Hills Community College, Attn. Financial Aid, 525 Grandview Avenue, Ottumwa, Iowa 52501
Fax: 641-683-5741, Phone: 800-726-2585, ext. 5262 or 641-683-5262, email us at: OneStop@indianhills.edu
Centerville Campus: Indian Hills Community College, 721 North First Street, Centerville, IA 52544
Fax: 641-856-3158, Phone: 800-670-3641, ext. 2200 or 641-856-2143, ext. 2200 email us at: OneStop@indianhills.edu
To check the status of your documents, go to WebAdvisor and click the Financial Checklist, under the Financial Aid heading.
The instructions and certifications below apply to each parent included in the household. Complete this
section if the parents will not file and are not required to file a 2016 income tax return with the IRS.
1. Check the box that applies:
Neither parent was employed, and neither had income earned from work in 2016.
One or both parents were employed in 2016 and have listed below the names of all employers,
the amount earned from each employer in 2016, and whether an IRS W-2 form or an equivalent
document is provided. [Provide copies of all 2016 IRS W-2 forms issued to the parents by their
employers]. List every employer even if the employer did not issue an IRS W-2 form.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Parent Name Employer’s Name
Annual Amount
Earned in 2016
employed income
i.e. babysitting,
(Example) ABC’s Auto Body Shop
2. Provide copies of all 2016 IRS W-2 forms issued to the parents by their employers]. List every employer
even if the employer did not issue an IRS W-2 form.
3. Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2017 that
indicates a 2016 IRS income tax return was not filed with the IRS or other relevant tax authority.
A request to the IRS for a Verification of Nonfiling Letter can be made using the IRS “Get Transcript
Online” tool at www.irs.gov/Individuals/Get-Transcript or by submitting IRS Form 4506-T
and
checking box 7. Specify which tax year(s) you need, and mail or fax the completed form to the IRS at
the address or fax number provided in the instructions.
Check here if confirmation of nonfiling is provided.
Check here if confirmation of nonfiling will be provided later.
4. Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reported on the FAFSA must sign and date.
A hand written signature, not typed, is required.
________________________________________ ________________________
Student’s Signature
(Required) Date
________________________________________ ________________________
Parent’s Signature (Required) Date
WARNING: If you purposely give false or
misleading information, you may be
fined, sent to prison, or both.
