2020-21 Independent
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 your spouse (if applicable), 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 (Independent Student)
Number of Household Members: List below the people in the student’s household. Include:
The student.
The student’s spouse, if the student is married.
The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, 2020, through
June 30, 2021, even if the children do not live with the student.
Other people if they now live with the student and the student or spouse provides more than half of their support and will continue to provide
more than half of their support through June 30, 2021.
Number in college: Include in the space below information about any household member 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 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 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.
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 institution 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 IRS’s two-step
authentication
(Continued on next page)
C. (Continued)
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) or a signed copy of the 2018 income tax return and applicable schedules 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.
D. 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. Verification of 2018 Income Information for Student Nontax Filers
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 2018 income tax return with the IRS.
Check the box that applies:
The student and spouse were 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 an equivalent document is provided. [Provide copies of all 2018 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.
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
$
If you did NOT file a 2018 tax return, 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.
F. Certifications and Signatures
Each person signing below certifies that all of the information reported is complete and correct.
Print Student’s Name Student’s ID Number
Student’s Signature (Required) Date
Spouse’s Signature (Optional) Date
*Note: Verification of 2018 Income Information for Individuals with Unusual Circumstances
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.
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