Student Name _____________________________________________ Student ID or SSN _________________________
20182019 Verification of 2016 Income Information for Student 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 the student and spouse, if the student is married.
Complete this section if the student and spouse will not file and are not required to file a 2016 income tax
return with the IRS.
1. Check the box/es that applies:
The student was not employed and had no income earned from work in 2016.
The student was employed in 2016 and has listed below the names of all employers and the
amount earned from each employer in 2016. [Provide copies of all 2016 IRS W-2 forms issued
to the student and spouse by their employers]. List every employer even if the employer did not
issue an IRS W-2 form.
The spouse was not employed and had no income earned from work in 2016.
The spouse was employed in 2016 and has listed below the names of all employers and the
amount earned from each employer in 2016. [Provide copies of all 2016 IRS W-2 forms issued
to the student and spouse 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.
List Student or Spouse’s
Name
Employer’s Name
Annual Amount
Earned in 2016
Check if self-
employed income
i.e. babysitting,
mowing, etc.
(Example) John Smith
(Example) ABC’s Auto Body Shop
$4,500.00
2. Provide copies of all 2016 IRS W-2 forms issued to the student and spouse, if the student is married, by
their employers.
3. If you are an Independent student, 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. Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct.
A hand written signature, not typed, is required.
________________________________________ ________________________
Student’s Signature
(Required) Date
________________________________________ ________________________
Spouse’s Signature
(Required if a Nonfiler) Date
WARNING: If you purposely give false or
misleading information, you may be
fined, sent to prison, or both.
If you're unable to provide your Form W-2
The quickest way to obtain a copy of your current year Form W-2 is through your employer. If you can't get
your Form W-2 from your employer, you can get a wage and income transcript by using Get Transcript Online
at www.irs.gov/Individuals/Get-Transcript. You can also use Form 4506-T
, Request for Transcript of Tax
Return. Check the box for Form W-2, 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. Allow 5 to 10 days from the IRS received
date to receive the transcript.
Verification of Non-filing Letter - provides proof that the IRS has no record of a filed Form 1040, 1040A or
1040EZ for the year you requested. It doesn't indicate whether you were required to file a return for that year.
This letter is available after June 15 for the current tax year or anytime for the prior three tax years using Get
Transcript Online or Form 4506-T. You must use Form 4506-T if you need a letter for tax years older than the
prior three years.
Table 1-1. 2016 Filing Requirements Chart for Most Taxpayers
Note. You must file a return if your gross income was at least the amount shown in the last column.
IF your filing status is. . .
AND at the end of 2016
you were
*
. . .
THEN file a return if your gross
income
**
was at least. . .
Single
under 65
$10,350
65 or older
$11,900
Head of household
under 65
$13,350
65 or older
$14,900
Married filing jointly
***
under 65 (both spouses)
$20,700
65 or older (one spouse)
$21,950
65 or older (both spouses)
$23,200
Married filing separately
any age (if your spouse itemizes deductions)
$ 4,050
Qualifying widow(er)
under 65
$16,650
with dependent child
65 or older
$17,900
*
If you were born before January 2, 1952, you are considered to be 65 or older at the end of 2016. (If your spouse
died in 2016 or if you arepreparing a return for someone who died in 2016, see Pub. 501.)
**
Gross income means all income you receive in the form of money, goods, property, and services that isn't exempt
from tax, including any income from sources outside the United States or from the sale of your main home (even
if you can exclude part or all of it). It also includes gains, but not losses, reported on Form 8949 or Schedule D.
Gross income from a business means, for example, the amount on Schedule C, line 7, or Schedule F, line 9. But,
in figuring gross income, don't reduce your income by any losses, including any loss on Schedule C, line 7, or
Schedule F, line 9. Don't include any social security benefits unless (a) you are married filing separately and you
lived with your spouse at any time in 2016 or (b) one-half of your social security benefits plus your other gross
income and any tax-exempt interest is more than $25,000 ($32,000 if married filing jointly). If (a) or (b) applies,
see the Instructions for Form 1040 or Pub. 915, Social Security and Equivalent Railroad Retirement Benefits, to
figure the taxable part of social security benefits you must include in gross income.
***
If you didn't live with your spouse at the end of 2016 (or on the date your spouse died) and your gross income
was at least $4,050, you must file a return regardless of your age.
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