Fillable CSU los angeles Verification Worksheet (Dependent) 2020-21

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CSU los angeles Verification Worksheet (Dependent) 2020-21

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1
2020-2021
FVERDO
For office use only:
Verification Worksheet (Dependent)
Your 2020-21 Free Application for Federal Student Aid (FAFSA) or Dream (AB540) Application was selected for review in a process called
“Verification.” The Financial Aid Office will compare your FAFSA with the information on this worksheet and any other required
documents. If there are any discrepancies, your FAFSA or Dream Application information will need to be corrected. Please keep in
mind that incomplete forms will create a delay in processing.
Instructions:
You and at leas
t one parent must complete and sign this worksheet.
Submit the worksheet and any required documents to the Center for Student Financial Aid.
Section A. Student’s Information
__________________________________ ___________________________ _____ ______________________________________
Last Name First Name M.I. Cal State LA Campus Identification Number (CIN)
__________________________________________
Phone Number
Section B. Student’s Family Information
List the people in your parent(s) household. Please include the following:
Yourself and your parent(s) (including a stepparent) even if you do not live with your parent(s).
Your parent(s)’ othe
r children if your parent(s) 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/Dream
Application for 2020-2021. Include children who meet either of these standards, even if they do not live with your parent(s).
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will continue
to provide more than half of their support through June 30, 2021.
Include the names of all household members that meet the definition above in the space(s) below. Also, include the name of the
college for any household member(s) (excluding your parents) who 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.
Attach a separate page if needed. Note: Additional documentation may be required if there is reason to believe that the information
regarding the household members enrolled in an eligible postsecondary educational institution is inaccurate.
Full Name Age Relationship College (do not abbreviate, i.e. USC)
Will be Enrolled at Least
Half-Time
Martha Jones (example) 24 Sister California State University, Los Angeles Yes
Self/Student
Center for Student Financial Aid
California State University, Los Angeles
5151 State University Drive, SA 124
Los Angeles, CA 90032
-8402
Phone: (323) 343
-6260
Fax: (323) 343-3166
Print Form
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2
Section C. Student’s Income Verification (Use 2018 Income Only)
PART 1: Tax Return Filers (This question is only for those who filed a 2018 Federal Income Tax Return with the IRS)
NOTE: The IRS Data Retrieval Tool is not available for Dream (AB540) Application Filers
Did you file a 2018 federal tax return with the IRS?
Yes If yes, complete Part 1 and 1A and SKIP Part 2 No If no, complete Part 2
Check only 1 box below:
Check here if you are a FAFSA filer and you used the IRS Data Retrieval Tool at FAFSA on the Web to retrieve and
transfer your 2018 IRS income information onto your FAFSA. The Financial Aid Office will upload the Data Retrieval
Information to complete the verification process.
Check here if (1) you are a Dream Application Filer OR (2) a FAFSA Filer but are unable/choose not to use the IRS Data
Retrieval Tool. You must submit the following:
A copy of your 2018 IRS Tax Return Transcript from the IRS
A 2018 IRS Tax Return Paper Transcript may be obtained through the following options:
Online Request: www.IRS.gov. Request “IRS Tax Return Transcript”
Telephone Request: Call 1-800-908-9946
Paper Requests: Submit IRS Form 4506T-EZ or IRS Form 4506-T to the IRS.
Part 1A: (This question is only for those who filed a 2018 Federal Tax Return, but then had to make corrections through a 1040X
form) Did you file an amended 2018 Federal Tax Return?
YES. You must submit the following:
A copy of your parent(s)’ 2018 IRS Tax Return Transcript AND
A signed copy of their Amended 2018 form 1040X
NO. This section is complete
PART 2: Non-tax Filers (This question applies to those who did not file a 2018 income tax return and were not required to do
so) Verification of non-filing status: Check only 1 box below:
Check here if you were not employed and had no income from work during 2018.
Check here if you did not file a tax return but were employed in 2018. Complete the employer information below and
attach a copy of each W-2/1099 form.
List below the name of all employers and the amount you earned from work from each employer. Attach a copy of your W-2 form(s) or
1099 issued by your employers. If more space is needed, attach a separate page with the student’s name and CIN# at the top. List
every employer even if they did not issue an IRS W-2 or 1099 form.
Employer’s Name/ Source of Income 2018 Amount Earned/ Income
Suzy’s Auto Body Shop (example) $1,900 (example)
TOTAL Amount of Income Earned From Work: $
(Please continue and complete Section D: Parent’s Income Verification Information)
3
Section D. Parent’s Income Verification (Use 2018 Income Only)
Note: If two
parents we
re re
p
o
rt
e
d
in Section B of this worksheet, the instructions and certifications below refer and apply to both parents.
PART 1: Tax Return Filers (This question is only for those who filed a 2018 Federal Income Tax Return with the IRS.)
NOTE: The IRS Data Retrieval Tool is not available for Dream (AB540) Application Filers.
No If no, complete Part 2
Did your parent(s) file a 2018 federal tax return with the
IRS? Yes If yes, complete Part 1 and 1A
and SKIP Part 2
Check only 1 box below:
Check here if you are a FAFSA filer and you used the IRS Data Retrieval Tool at FAFSA on the Web to retrieve and
transfer your parent(s)’ 2018 IRS income information onto your FAFSA. The Financial Aid Office will upload the Data
Retrieval Information to complete the verification process. Proceed to Part 1A.
Check here if (1) you are a Dream Application Filer OR (2) a FAFSA Filer but are unable to/choose not to use the IRS
Data Retrieval Tool. Your parent(s) must submit the following:
A copy of your parent(s)’ 2018 IRS Tax Return Transcript from the IRS
A 2018 IRS Tax Return Paper Transcript may be obtained through the following options:
Online Request: www.IRS.gov. Request “IRS Tax Return Transcript”
Telephone Request: Call 1-800-908-9946
Paper Requests: Submit IRS Form 4506T-EZ or IRS Form 4506-T to the IRS.
Part 1A: (This question is only for those who filed a 2018 Federal Tax Return, but then had to make corrections through a 1040X form)
Did your parent(s) file an amended 2018 Federal Tax Return?
YES. You must submit the following:
A copy of your parent(s)’ 2018 IRS Tax Return Transcript AND
A signed copy of their Amended 2018 form 1040X
NO. This section is complete
PART 2: Non-tax Filers (This question applies to those who did not file a 2018 income tax return and were not required to do
so) Part 2A: Verification of non-filing status: Check only 1 box below:
Check here if your parent(s) were not employed and had no income from work during 2018. Complete Section 2B.
Check here if your parent(s) did not file a tax return but were employed in 2018. Complete the chart below, submit a
copy of each W-2/1099 form received, and complete Section 2B.
List below
the name of all employers and the amount your parents earned from work from each employer. Attach a copy of each W-2
form(s) or 1099 issued by the employers. If more space is needed, attach a separate page with the student’s name and CIN# at the top.
List every employer even if they did not issue an IRS W-2 or 1099 form.
Employer’s Name/ Source of Income 2018 Amount Earned/ Income
Suzy’s Auto Body Shop (example) $2,000.00 (example)
TOTAL Amount of Income Earned From Work: $
(Please continue and complete Section 2B: Verification of non-filing identification)
4
Part 2B: Verification of non-filing identification: Check only 1 box below and attach the appropriate documentation:
Check here if your parent(s) have a valid SSN (Social Security Number), ITIN (Individual Taxpayer Identification
Number), or EIN (Employer Identification Number). If you check this box, please provide one of the following
documentation dated on or after October 2019:
o IRS Verification of Nonfiling, or
o IRS Form 13873 that clearly states IRS has "No record of return filed" or "No transcript on file" for tax payer, or
o Any IRS documents that clearly states IRS has "no record of return filed" or "No transcript on file" for tax payer
NOTE: The
IRS documents will indicate that the IRS does not have a tax return record on file for the relevant tax year,
such as: "No record of return filed" or "No transcript on file." Any IRS documents with unclear messages, such as
"could not be processed" or the "request could not be honored" will not be accepted as verification of nonfiling.
Check here if your parent(s) DO NOT have a valid SSN (Social Security Number), ITIN (Individual Taxpayer
Identification Number), or EIN (Employer Identification Number).
Section
E. Please Sign and Date Below
By signing this worksheet, I certify that all the information reported on this worksheet is complete and
correct. The student and parent listed on the 2020-21 FAFSA must sign this worksheet.
Student’s Signature Date
Parent’s Signature Date
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined,
sentenced to jail, or both.
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CSU los angeles Verification Worksheet (Dependent) 2020-21

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Completed 16 April 2020

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