2020-21 Dependent
Number in Household Worksheet
Your 2020-21 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that 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, we will compare your FAFSA with the information on this institutional verification document and with any other required documents. If
there are differences, your FAFSA information may need to be corrected. You and a parent whose information was reported on the FAFSA must
complete and sign this institutional verification document, attach any required documents, and submit the form and other required documents to
us. We may ask for additional information. If you have questions about verification, contact us as soon as possible so that your financial aid will
not be delayed.
A. Student’s Information
Student’s Last Name First Name M.I. Student’s ID Number
Student’s Street Address (include apt. no.) Student’s Date of Birth
City State Zip Code Phone Number Student’s Email Address
B. Number of Household Members and Number in College (Dependent Student)
Number of Household Members: List below the people in the parents’ household. Include:
The student.
The parents (including a stepparent) even if the student doesn’t live with the parents.
The parents’ other children if the parents will provide more than half of their support from July 1, 2020, through June 30, 2021, or if the other
children would be required to provide parental information if they were completing a FAFSA for 20202021. Include children who meet either
of these standards even if the children do not live with the parents.
Other people if they now live with the parents and the parents provide more than half of their support and will continue to provide more than
half of their support through June 30, 2021.
Number in College: Please include in the space below information about any household member, excluding the parent(s), who is or will be
enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1,
2020 and June 30, 2021, and include the name of the college. If more space is needed, provide a separate page with the student’s name and ID
number at the top.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
(Yes or No)
Self
Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in eligible
postsecondary educational institutions is inaccurate.
C. STUDENT - Verification of 2018 Income Information for Student Tax Filers
Important Note: The instructions below apply to the student and spouse, if the student is married. Notify the financial aid office if the student or
spouse filed separate IRS income tax returns for 2018 or had a change in marital status after December 31, 2018.
Instructions: Complete this section if the student and spouse filed or will file a 2018 IRS income tax return(s). The best way to verify income is by
using the IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further documentation is needed
to verify 2018 income information that was transferred into the student’s FAFSA using the IRS DRT if that information was not changed by the
FAFSA filer.
Check the box that applies:
The student has used the IRS DRT in FAFSA on the Web to transfer 2018 IRS income tax return information into the student’s FAFSA.
The student has not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2018 IRS income tax return
information into the student’s FAFSA.
The student is unable or chooses not to use the IRS DRT in FAFSA on the Web, and instead will provide the school with a 2018 IRS
Tax Return Transcript(s).
A 2018 IRS Tax Return Transcript may be obtained through:
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.” The transcript is generally received within 10
business days from the IRS’s receipt of the online request.
(Continued on next page)
C. (continued)
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.” To use the Get Transcript Online tool, the
user must have (1) access to a valid email address, (2) a text-enabled mobile phone (pay-as-you-go plans cannot be used) in the
user’s name, and (3) specific financial account numbers (such as a credit card number or an account number for a home mortgage or
auto loan). The transcript displays online upon successful completion of the IRS’s two-step authentication.
Automated Telephone Request 1-800-908-9946. Transcript is generally received within 10 business days from the IRS’s receipt of the
telephone request.
Paper Request Form IRS Form 4506T-EZ or IRS Form 4506-T. The transcript is generally received within 10 business days from the
IRS’s receipt of the paper request form.
If the student and spouse filed separate 2018 IRS income tax returns, the IRS DRT cannot be used and the 2018 IRS Tax Return
Transcript(s) must be provided for each.
Check here if a 2018 IRS Tax Return Transcript(s) or a signed copy of the 2018 income tax return and applicable schedules
is provided.
Check here if a 2018 IRS Tax Return Transcript(s)or a signed copy of the 2018 income tax return will be provided later.
D. STUDENT - Untaxed portions of Pension and IRA Distributions (Excludes Rollovers)
$ IRA distributions: From 1040 lines (15a minus 15b) or 1040A lines (11a minus 11b)
$ Pensions: Form 1040 lines (16a minus 16b) or 1040A lines (12a minus 12b)
E. STUDENT - Verification of 2018 Income Information for Student Nontax Filers
The instructions and certifications below apply to the student. Complete this section if the student will not file and is not required to file a 2018
income tax return with the IRS.
Check the box that applies:
The student was not employed and had no income earned from work in 2018.
The student and/or spouse were employed in 2018 and have listed below the names of all employers, the amount earned from each
employer in 2018, and whether an IRS W-2 form or equivalent is provided. [Provide copies of all 2018 IRS W-2 forms issued to the student
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.
Employer’s Name
2018 Amount Earned
IRS W-2 Provided?
Suzy’s Auto Body Shop (example)
$2,000.00
Yes
Total Amount of Income Earned From Works in 2018
$
Note: We may require you to provide IRS documentation that indicates a 2018 IRS income tax return was not filed with the IRS.
F. PARENT - Verification of 2018 Income Information for Parent Tax Filers
Important Note: The instructions below apply to each parent included in the household. Notify the financial aid office if the parents filed separate
IRS income tax returns for 2018 or had a change in marital status after December 31, 2018.
Instructions: Complete this section if the parents filed or will file a 2018 IRS income tax return(s). The best way to verify income is by using the
IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further documentation is needed to verify
2018 income information that was transferred into the student’s FAFSA using the IRS DRT if that information was not changed.
Check the box that applies:
The parents have used the IRS DRT in FAFSA on the Web to transfer 2018 IRS income tax return information into the student’s FAFSA.
The parents have not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2018 IRS income tax
return information into the student's FAFSA.
The parents are unable or choose not to use the IRS DRT in FAFSA on the Web, and instead will provide the school with a 2018 IRS Tax
Return Transcript(s) or a signed copy of the 2018 income tax return and applicable schedules..
A 2018 IRS Tax Return Transcript may be obtained through:
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.” The transcript is generally received within
10 business days from the IRS’s receipt of the online request.
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.” To use the Get Transcript Online tool, the
user must have (1) access to a valid email address, (2) a text-enabled mobile phone (pay-as-you-go plans cannot be used) in the
user’s name, and (3) specific financial account numbers (such as a credit card number
or an account number for a home mortgage or auto loan). The transcript displays online upon successful completion of the IRSs two-
step authentication.
Automated Telephone Request 1-800-908-9946. Transcript is generally received within 10 business days from the IRS’s receipt of the
telephone request.
Paper Request Form IRS Form 4506T-EZ or IRS Form 4506-T. The transcript is generally received within 10 business days from the
IRS’s receipt of the paper request form.
If the parents filed separate 2018 IRS income tax returns, the IRS DRT cannot be used and the 2018 IRS Tax Return Transcript(s) must
be provided for each.
Check here if a 2018 IRS Tax Return Transcript(s) or a signed copy of the 2018 income tax return and applicable schedules
is provided.
Check here if a 2018 IRS Tax Return Transcript(s) or a signed copy of the 2018 income tax return and applicable schedules
will be provided later.
G. PARENT - Untaxed portions of Pension and IRA Distributions (Excludes Rollovers)
$ IRA distributions: From 1040 lines (15a minus 15b) or 1040A lines (11a minus 11b)
$ Pensions: Form 1040 lines (16a minus 16b) or 1040A lines (12a minus 12b)
H. PARENT - Verification of 2018 Income Information for Parent Nontax Filers
The instructions and certifications below apply to the parent and spouse, if the parent is married. Complete this section if the Parents will not file
and are not required to file a 2018 income tax return with the IRS.
Check the box that applies:
The Parent and spouse were not employed and had no income earned from work in 2018.
One or both parents were employed in 2018 and have listed below the names of all employers, the amount earned from each employer in
2018, and whether an IRS W-2 form or equivalent document is provided. [Provide copies of all 2018 IRS W-2 forms issued to the Parent
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.
Employer’s Name
2018 Amount Earned
IRS W-2 Provided?
Suzy’s Auto Body Shop (example)
$2,000.00
Yes
Total Amount of Income Earned From Work in 2018
$
Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2019 that indicates a 2018 IRS income tax return
was not filed with the IRS or other relevant tax authority, or a signed statement certifying that the individual attempted to obtain confirmation of
non-filing from the IRS or other relevant tax authority and was unable to obtain the required documentation.
Check here if confirmation of non-filing or a signed statement is provided.
Check here if confirmation of non-filing or a signed statement will be provided later.
I. Certifications and Signatures
Each person signing below certifies that all of the information report is complete and correct. The
student and at least one parent whose information was reported on the FAFSA must sign and date.
Print Student’s Name Student’s ID Number
Student’s Signature (Required) Date
Parent’s Signature (Required) Date
*Note: Information for Individuals with Unusual Circumstances (below)
Individuals Granted a Filing Extension by the IRS
An individual who is required to file a 2018 IRS income tax return and has been granted a filing extension by the IRS beyond the automatic six-month extension for tax year 2018, must
provide:
A copy of the IRS's approval of an extension beyond the automatic six-month extension for tax year 2018;
Verification of Non-filing (VNF) Letter (confirmation that the tax return has not yet been filed) from the IRS dated on or after October 1, 2019 or a signed statement certifying that the
individual attempted to obtain the VNF from the IRS and was unable to obtain the required documentation;
A copy of IRS Form W2 for each source of employment income received or an equivalent document for tax year 2018 and,
If self-employed, a signed statement certifying the amount of the individual’s Adjusted Gross Income (AGI) and the U.S. income tax paid for tax year 2018.
Note: An individual granted a filing extension beyond the automatic six-month extension may be required to submit tax information using the IRS Data Retrieval Tool, by obtaining a
transcript from the IRS, or by submitting a copy of the income tax return and the applicable schedules that were filed with the IRS that lists 2018 tax account information.
Individuals Who Filed an Amended IRS Income Tax Return
An individual who filed an amended IRS income tax return for tax year 2018 must provide a signed copy of the 2018 IRS Form 1040X, “Amended U.S. Individual Income Tax Return,” that
was filed with the IRS or documentation from the IRS that include the change(s) made by the IRS, in addition to one of the following:
IRS DRT information on an ISIR record with all tax information from the original tax return;
A 2018 IRS Tax Return Transcript (that will only include information from the original tax return and does not have to be signed), or any other IRS tax transcript(s) that includes all of
the income and tax information required to be verified; or
A signed copy of the 2018 IRS Form 1040 and the applicable schedules that were filed with the IRS.
Individuals Who Were Victims of IRS Tax-Related Identity Theft
An individual who was the victim of IRS tax-related identity theft must provide:
A Tax Return DataBase View (TRDBV) transcript obtained from the IRS, or if unable to obtain a TRDBV, an equivalent document provided by the IRS or a copy of the signed 2018
income tax return and applicable schedules the individual filed with the IRS; and
A statement signed and dated by the tax filer indicating that he or she was a victim of IRS tax-related identity theft and that the IRS is aware of the tax-related identity theft.
Individuals Who Filed Non-IRS Income Tax Returns
A tax filer who filed an income tax return with a tax authority other than the IRS may provide a signed copy of his or her income tax return that was filed with the relevant tax authority.
However, if we question the accuracy of the information on the signed copy of the income tax return, the tax filer must provide us with a copy of the tax account information issued by the
relevant tax authority before verification can be completed.
WARNING: If you
purposely give
false or misleading
information you
may be fined, sent
to prison, or both.
click to sign
signature
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