Fillable 2021-2022 V1-D Verification Worksheet Dependent Student (Lurleen B Wallace Community College)

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2021-2022 V1-D Verification Worksheet Dependent Student (Lurleen B Wallace Community College)

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BROWSE LURLEEN B WALLACE COMMUNITY COLLEGE FORMS

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Revised 11/25/2020
2021-2022 V1-D Verification Worksheet
Dependent Student
Number of Household Members and Number in College
Dependent Student’s Information
______________________________________________________________ ___________________________________
Student’s Last Name Student’s First Name Student’s M.I. Student Identification Number
______________________________________________________________
Student’s Street Address (include apt. no.)
______________________________________________________________ ___________________________________
City State Zip Code Student’s Email Address
______________________________________________________________ ___________________________________
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
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 the children’s support from July 1, 2021, through June 30, 2022, or if
the other children would be required to provide parental information if they were completing a FAFSA for 2021–2022. Include children who
meet either of these standards, even if a child does not live with the parents.
Other people if they now live with the parents and the parents provide more than half of the other person’s support and will continue to provide
more than half of that person’s support through June 30, 2022.
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, 2021, and June 30, 2022, 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
Lurleen B. Wallace Community College
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.
Your 2021–2022 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification.
The law states that before awarding Federal Student Aid, we may ask you to confirm the information you and your parents
reported on your FAFSA. To verify that you provided correct information the financial aid administrator at your school will
compare your FAFSA with the information on this worksheet and with any other required documents. If there are
differences, your FAFSA information may need to be corrected. You and at least one parent must complete and sign this
worksheet, attach any required documents, and submit the form and other required documents to the financial aid
administrator at your school. Your school may ask for additional information. If you have questions about verification,
contact your financial aid administrator as soon as possible so that your financial aid will not be delayed.
V1-D
Student Name:_____________________________ Student Number:_______________________ Page 2
Revised 11/24/2020
Verification of 2019 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 2019 or had a change in marital status after December 31, 2019.
Instructions: Complete this section if the student filed or will file
a 2019 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 2019
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 2019 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 2019 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 signed copy of the
2019 IRS Tax Return and applicable schedules or a copy of the 2019 IRS Tax Return Transcript.
A 2019 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.
• 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 2019 IRS income tax returns, the IRS DRT cannot be used and the 2019 IRS Tax Return Transcript(s) or a
signed copy of the 2019 income tax return and applicable schedules must be provided for each.
____ Check here if a signed copy of the 2019 IRS Tax Return or the Tax Return Transcript(s) is provided.
____ Check here if a signed copy of the 2019 IRS Tax Return or the Tax Return Transcript(s) will be provided later.
Verification of 2019 Income Information for Student Nontax Filers (Please skip this portion if you filed taxes):
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 2019
income tax return with the IRS.
Check the box that applies:
The student was not employed and had no income earned from work in 2019.
The student was employed in 2019 and has listed below the names of all employers, the amount earned from each employer in 2019, and
whether an IRS W-2 form or an equivalent document is provided. [Provide copies of all 2019 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
IRS W-2 or an Equivalent
Document Provided?
Annual Amount
Earned in 2018
(Example) ABC’s Auto Body Shop
Yes
$4,500.00
Total Amount of Income Earned From Work
$
V1-D
Student Name:_____________________________ Student Number:_______________________ Page 3
Revised 11/24/2020
Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2020 that indicates a 2019 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.
Verification of 2019 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 2019 or had a change in marital status after December 31, 2019.
Instructions: Complete this section if the parents filed or will file a 2019 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 2019
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 2019 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 2019 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 signed copy of the
2019 IRS Tax Return (s) and applicable schedules or a copy of the 2019 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.
• 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 parents filed separate 2019 IRS income tax returns, the IRS DRT cannot be used and the signed 2019 IRS Tax Returns or 2019 Tax
Return Transcript(s) must be provided for each.
____ Check here if a signed copy of the 2019 IRS Tax Return or the Tax Return Transcript(s) is provided.
____ Check here if a signed copy of the 2019 IRS Tax Return or the Tax Return Transcript(s) will be provided later.
V1-D
Student Name:_____________________________ Student Number:_______________________ Page 4
Revised 11/24/2020
Verification of 2019 Income Information for Parent Nontax Filers (Please skip this portion if taxes were filed):
The instructions and certifications below apply to each parent included in the household. Complete this section only if the parents will not file and
are not required to file a 2019 income tax return with the IRS.
Check the box that applies:
Neither parent was employed, and neither had income earned from work in 2019.
One or both parents were employed in 2019 and have listed below the names of all employers, the amount earned from each employer in
2019, and whether an IRS W-2 form or an equivalent document is provided. [Provide copies of all 2019 IRS W-2 forms issued to the parents
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
IRS W-2 or an Equivalent
Document Provided?
Annual Amount
Earned in 2018
(Example) ABC’s Auto Body Shop
Yes
$4,500.00
Total Amount of Income Earned From Work
$
Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2020 that indicates a 2019 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.
Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reported on the FAFSA must sign and date. I (we) give
LBWCC authorization to submit corrections to my ISIR/SAR
For verification purposes.
__________________________________________________ ________________________
Print Student’s Name Student’s ID Number
__________________________________________________ ________________________
Student’s Signature Date
__________________________________________________ ________________________
Parent’s Signature Date
WARNING: If you purposely give false or
misleading information, you may be
fined, sent to prison, or both.
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2021-2022 V1-D Verification Worksheet Dependent Student (Lurleen B Wallace Community College)

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Completed 2 February 2021

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