1/11/2019
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Student Name ___________________________________________ HCC ID# _____________
Last First MI
Section One: Select if you are a dependent or independent student:
Dependent –Go to Section Two. Independent –Go to Section Three.
Section Two: Dependent Student
Select ONE option below that describes your 2017 income as stated on the 2019-2020 FAFSA:
1. You did not work/did not receive unemployment and did not/will not file taxes in 2017. Go to Section Four once
this option is checked.
2. You worked or received unemployment in 2017, BUT did not receive income over the IRS filing limits AND DID
NOT/WILL NOT FILE. List all earned income in the boxes below. Submit all W2s/1099’s for 2017 WITH THIS
FORM. Go to Section Four once this is completed.
Did you receive income NOT reported on a W2? Yes No
If yes, list that income below with the sources and amounts of income earned. Use separate sheet if
needed.
Source of income or Employer Name on W2
2017 Earned Income
$
$
3. You imported tax information directly into the FAFSA by using the IRS Data. Retrieval. If you have not yet used
this option and would like to, please follow the directions below:
DIRECTIONS: To use the Data Retrieval:
1. Go to https://fafsa.ed.gov and select “Make a correction”; Log-in using FSA ID and password
2. Under “Financial Information” tab select that you have already filed
3. Use Link to IRS and transfer tax information into your FAFSA.
4. Sign & Submit your FAFSA
Sign the bottom of this form and submit to HCC Financial Aid Office after waiting one week. This will
allow time for the correction to come to us.
4. You are submitting IRS Tax Return Transcripts OR Signed IRS Tax Returns for the 2017 tax year.
Go to Section Four once this option is checked. DIRECTIONS: To order a tax return transcript
Get Transcript by MAIL Go to www.irs.gov, under the Tools heading, click "Get a tax transcript.” Clic
kGet
Transcript
by
M
AIL.” Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account
Transcript.” This takes 5 to 10 days
Get Transcript ONLINE Go to www.irs.gov, under the Tools heading, click "Get a tax transcript." Click “Get
Transcript ONLINE.” Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account
Transcript.”
19CINCMS
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
2019-2020
Income Statement
Student/Spouse
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
19CINCMS 1/11/2019
Section Three: Independent Student
Select ONE option below that describes your 2017 income as stated on the 2019-2020 FAFSA:
1. You (and/or your spouse) did not work and did not receive unemployment in 2017. If you check this option, a
Verification of Non-Filing letter from the IRS is required. Go to Section Four once this option is
completed. Please follow the directions below to order the letter.
DIRECTIONS: To order a verification of non-filing letter
Get Transcript by MAIL Can be obtained by from the IRS using Form 4506-T and checking Box 7. Be sure to list
Year or period requested as 12/31/2017. This takes 5 to 10 days.
If you attempted to obtain a Verification of Non-Filing Letter from the IRS but you were unable to obtain
the required documentation, check here
2. You (and/or your spouse) worked or received unemployment in 2017, BUT did not receive income over the IRS
filing limits AND DID NOT/WILL NOT FILE. List all earned income in the boxes below. Submit all W2s/1099’s for
2015 WITH THIS FORM. If you check this option, a Verification of Non-Filing letter from the IRS is required.
Go to Section Four once this option is completed. Please follow the directions below to order the letter.
DIRECTIONS: To order a verification of non-filing letter
Get Transcript by MAIL Can be obtained by from the IRS using Form 4506-T and checking Box 7. Be sure to list
Year or period requested as 12/31/2017. This takes 5 to 10 days.
If you attempted to obtain a Verification of Non-Filing Letter from the IRS but you were unable to obtain
the required documentation, check here
Did you receive income NOT reported on a W2? Yes No
If yes, list that income below with the sources and amounts of income earned. Use separate sheet if
needed.
Source of income or Employer Name on W2
2017 Earned Income
$
3. You (and/or your spouse) imported tax information directly into the FAFSA by using the IRS Data. Retrieval. If
you have not yet used this option and would like to, please follow the directions below:
DIRECTIONS: To use the Data Retrieval:
1. Go to https://fafsa.ed.gov and select “Make a correction”; Log-in using FSA ID and password
2. Under “Financial Information” tab select that you have already filed
3. Use Link to IRS and transfer tax information into your FAFSA.
4. Sign & Submit your FAFSA
Sign the bottom of this form and submit to HCC Financial Aid Office after waiting one week. This will
allow time for the correction to come to us.
4. You (and/or your spouse) are submitting IRS Tax Return Transcripts OR Signed IRS Tax Returns for the 2017 tax
year. Go to Section Four once this option is checked.
DIRECTIONS: To order a tax return transcript
Get Transcript by MAIL Go to www.irs.gov, under the Tools heading, click "Get a tax transcript.” Click “Get
Transcript by MAIL.” Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account
Transcript.This takes 5 to 10 days
Get Transcript ONLINEGo to www.irs.gov, under the Tools heading, click "Get a tax transcript." Click “Get
Transcript ONLINE.” Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account
Transcript.
Section Four: Sign
By Signing this form you are certifying that all the information reported on it is complete and correct.
__________________________________________________ ______________________
Student Signature Date
Office Use Only: IRS DRT CODE ________ Initials ______ Income listed? Yes __ No __