C.aldw II Watauga
2020 - 2021
Pension and Annuity Rollover Worksheet
Student Name Student ID
Phone Number
Complete this form if all or some of your or your parent's IRA or Pension has been rolled over (or your spouse’s if you are
married), and the rolled over amount is showing on your 2020-21 FAFSA as untaxed IRS distributions or untaxed pensions.
Federal Regulations state that if you receive a lump-sum distribution from a pension, annuity, profit-sharing or retirement
plan, IRA, Insurance contract, etc., you can roll over the distribution into another qualified retirement plan or IRA and keep it
in a tax-deferred status. These rolled over funds should not be reported on the FAFSA as untaxed income, however if you used the
IRS Data Retrieval Tool when completing the FAFSA, the retrieval tool would not recognize the rollover.
IRA distributions, Pensions, and Annuities are taken from lines 4a and 4b of the IRS form 1040. Please review your individual
tax return, and indicate if all or some of the distribution was reinvested.
Attach documentation from the financial institution handling the investment to show the amount reinvested or submit
your 1099-R for 2018.
Type of Distribution Total Amount Taxable Amount Untaxed Amount
on Tax Return
IRA Distributions $ $ $
Pensions and Annuities $ $ $
Certification and Signatures:
I understand if I purposely give false or misleading information I may be fined, sentenced to jail, or both.
Amount of
Some $
Some $
Student Signature
Parent Signature
Return completed worksheet(s) to:
Caldwell Community College and Technical Institute
Office of Financial Aid
E-mail finaid@cccti.edu
Caldwell Campus 2855 Hickory Blvd., Hudson, NC 28638 Watauga Campus PO Box 3318, Boone, NC 28607
Fax: 828.726.2709 Fax: 828.297.1729
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