Document Submission:
Fax: 312.567.3982
Office of Financial Aid
Perlstein Hall, 206
10 W. 33
Chicago, IL 60616
Phone: 312.567.7219
Additional Information of Untaxed Income
Your 2020 Free Application for Federal Student Aid (FAFSA) was selected for review through a process
called verification. Verification is the U.S. Department of Education’s method of confirming data
on your FAFSA and requires the Office of Financial Aid to collect various forms of documentation.
After all documentation has been submitted, check your Illinois Tech hawk email regularly as our
office may have follow-up questions about the information submitted.
You have been asked to complete this form because your 2020-2021 FAFSA indicates you received
untaxed income from one of the five income sources listed below, or because the Department of
Education wants to confirm you did not receive income from any of the five income sources listed
Student Information
_____________________________________________ ____________________________________________ _
Last Name First Name
_____________________________________________ ___________________________________________ __
Campus-Wide ID (A#) Telephone Number
Untaxed Income Verification
Please review each statement for you or a parent (and/or spouse) to determine if untaxed income was received
from any of the listed sources in 2018:
If untaxed income was received: mark the applicable checkbox(es) and complete the “Recipient
Information section”
If you did not receive any untaxed income: mark “No Income Received” for each applicable category
1. Child support received for any children in household. Do not include foster care or adoption payments. (FAFSA
Questions 44.c for students and 92.c for parents)
Student/Spouse Parent(s) No Income Received
2. Housing, food and other living allowances paid to members of the
military, clergy and others including cash
payments and cash value of
benefits received. Do not include the value of on-base military housing or the value
of a basic military allowance for housing. (FAFSA Questions 44.f for students and 92.f for parents)
Student/Spouse Parent(s) No Income Received
3. Veterans non-education benefits such as Disability, Death Pension, Dependency & Indemnity Compensation
(DIC) and/or VA Educational
Work-Study allowances. (FAFSA Questions 44.g for students and 92.g for parents)
Student/Spouse Parent(s) No Income Received
Untaxed Income Verification (continued)
4. Other untaxed income not reported, such as workers’ compensation, disability benefits, foreign income etc. Also
include the untaxed portions of health savings accounts from IRS Form 1040 Schedule 1, line 25. Do not include
extended foster care benefits, student aid, earned income credit, additional child tax credit, welfare payments,
untaxed Social Security benefits,
Supplemental Security Income, Workforce Innovation and Opportunity Act
Educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible
spending arrangements (e.g.,
cafeteria plans), foreign income exclusion, credit for federal tax on
special fuels, or
ny items reported or excluded in lines 1-3 above. (FAFSA Questions 44.h for students and 92.h parents)
Student/Spouse Parent(s) No Income Received
5. Money received, or paid on your behalf (e.g., bills), not reported somewhere else in this form from a friend,
relative, or parent not listed on the FAFSA. Include money you received from a parent or person whose financial
information is not reported on your FAFSA and is not a part of a legal child support agreement. Also include
distributions you received from a 529 plan that is owned by someone other than your parent(s). Do not include
support from a parent whose information was reported on your FAFSA. (FAFSA Question 44.i)
Student/Spouse Parent(s) No Income Received
Recipient Information
Please elaborate on any checked boxes from the “Untaxed Income Verification” section by specifying the recipient
and value of each source of untaxed income.
Description of Untaxed Income
Recipient’s Full Name and Relationship
2018 Total Value
Example: #5
Rent payments from my uncle
Binglei Chen (Self)
I certify that the information provided to the Office of Financial Aid is true and correct.
Student Signature (must print and sign) Date Parent Signature (dependent students only) Date