Fillable 2021 2022 VERIFICATION STATUS 1 DEPENDENT WORKSHEET (Del Mar College)

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2021 2022 VERIFICATION STATUS 1 DEPENDENT WORKSHEET (Del Mar College)

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2021 – 2022
VERIFICATION STATUS 1
DEPENDENT WORKSHEET
A. Student’s Information
First Name MI Last Name Student ID Number
Address (include Apt.#) City State Zip Code Date of Birth
Primary Phone # Secondary Phone # Personal Email
B. Number of Household Members and Number in College
HOUSEHOLD
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, excluding the parents, 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
Del Mar 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.
Student Name: ___________________________________________ Student ID #: ______________________
C. Verification of 2019 Income Information for Student Tax Filers
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 institution with a 2018 IRS Tax Return Transcript or a signed copy of
the 2019 income tax return and applicable schedules.
____ Check here if a 2019 IRS Tax Return Transcript or a signed copy of the 2019
income tax return and applicable schedules is pr
ovided.
____ Check here if a 2019 IRS Tax Return Transcript or a signed copy of the 2019
income tax return and applicable schedules will be provided later.
D. Verification of 2019 Income Information for Student Nontax Filers
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 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. It is MANDATORY to
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 2019
Student Name: ___________________________________________ Student ID #: ______________________
E. Verification of 2019 Income Information for Parent Tax Filers
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.
Important Notes: 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. If
the parents 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 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 institution with a 2019 IRS Tax Return Transcript(s) or a
signed copy of the 201
9 income tax return and applicable schedules.
____ Check here if a 2019 IRS Tax Return Transcript(s) or a signed copy of the 2019
income tax return and applicable schedules is provided.
____ Check here if a 2019 IRS Tax Return Transcript(s) or a signed copy of the 2019
income tax return and applicable schedules will be provided later.
F. Verification of 2019 Income Information for Parent Nontax Filers
Complete this section if the parents will not file and are not required to file a 2019 income tax return with the IRS.
The instructions and certifications below apply to each parent included in the household.
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. It is
MANDATORY to 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?
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 Verification of Non-filing (VNF) Letter from the IRS or other relevant tax
authority and was unable to obtain the required documentation.
____ Check here if the IRS Verification of Non-filing (VNF) Letter or a signed statement is provided.
____ Check here if the IRS Verification of Non-filing (VNF) Letter or a signed statement will be provided later.
Annual Amount
Earned in 2019
Student Name: ___________________________________________ Student ID #: ______________________
G. Verification of 2019 Income Information for Individuals with Unusual Circumstances
Instructions: Check the box that applies to the circumstance(s) listed below, if none apply leave blank.
Student
Individuals Granted a Filing Extension by the IRS
Parent(s)
An individual who is required to file a 2019 IRS income tax return and has been granted a filing extension by the
IRS beyond the automatic six-month extension for tax year 2019, must provide:
A copy of the IRS's approval of an extension beyond the automatic six-month extension for tax year 2019; and
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, 2020 or a signed statement certifying that the individual attempted to obtain the VNF from the IRS
and was unable to obtain the required documentation; and
A copy of IRS Form W–2 for each source of employment income received or an equivalent document for tax year
2019, and/or
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 2019.
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 2019 tax account information.
Student
Individuals Who Filed an Amended IRS Income Tax Return
Parent(s)
An individual who filed an amended IRS income tax return for tax year 2019 must provide the following:
A signed copy of the 2019 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; and
A 2019 IRS Tax Return Transcript that includes all of the income and tax information required to be verified; or a
signed copy of the 2019 IRS Form 1040 and the applicable schedules that were filed with the IRS.
Student
Individuals Who Were Victims of IRS Tax-Related Identity Theft
Parent(s)
An indi
vidual 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 2019 income tax return and applicable schedules the
individua
l 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.
.
Student
Individuals Who Filed Non-IRS Income Tax Returns
Parent(s)
A tax f
iler 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.
Student Name: ___________________________________________ Student ID #: ______________________
H. Certifications and Signatures
Each person signing below certifies that all the information
reported is complete and correct. The student and one parent
whose information was reported on the FAFSA must sign and date.
_____________________________________________________ _____________________________
Student’s Signature (Required) Date
_____________________________________________________ _____________________________
Parent’s Signature (Required) Date
West Campus: Coleman Center – Rm 140
Phone: (361) 698-1726
Fax: (361) 698-2695
How to Obtain an IRS Tax Return Transcript, Verification of
Non-filing (VNF) Letter, or Wage & Income Statement
• Get Transcript by Mail – Go to www.irs.gov, click "Get Your Tax Record.” Click “Get Transcript
by Mail.” Make sure to request the “Return Transcript” and NOT the “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, click "Get Your Tax Record." Click “Get Transcript
Online.” Make sure to request the “Return Transcript” and NOT the “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. The 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.
• Request an Appointment with a Local IRS Representative – 1-844-545-5640
555 N. Carancahua St.
Corpus Christi, TX 78401
Monday – Friday 8:30AM - 4:30PM
WARNING: If you purposely give
false or misleading information, you
may be fined, sent to prison, or both.
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2021 2022 VERIFICATION STATUS 1 DEPENDENT WORKSHEET (Del Mar College)

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Completed 18 May 2021

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