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ElectronicDVF Distributed (Orange County Community College)

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*DVF*
115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-4194
1 Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
www.sunyorange.edu
1516 DEPENDENT VERIFICATION FORM (V1 / V5 / V6)
Your 2015 -20156 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called Verification. The law says 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 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 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 your financial aid will not be delayed.
A. STUDENT INFORMATION
Student ID # A __ __ __ __ __ __ __ __
First Name:__________________________________MI_____Last Name:______________________________________
Date of Birth: __ __ / __ __ / __ __ __ __
Phone:( __ __ __ ) __ __ __ - __ __ __ __ E-mail: _____________________________ @ _____________________
B. DEPENDENT STUDENT'S FAMILY INFORMATION
List the people in your household below: Include:
Yourself
Your parent(s) /step-parent
Children, if any, that your parent(s) / step-parent will provide more than half of their support from July 1, 2015, through
June 30, 2016, or if the child would be required to provide your parent(s) / step-parent information if they were
completing a FAFSA for 2015 -2016. Include children who meet either of these standards, even if they do not live with
you.
Other people if they now live with you and your parent(s) / step-parent provides more than half of their support and will
continue to provide more than half of their support through June 30, 2016.
If anyone listed below will be enrolled at least half time, in a degree, diploma, or certificate program at a postsecondary
educational institution any time between July 1, 2015, and June 30, 2016 you MUST include the name of the college he/she is
attending.
Full Name
Age
Relationship
College
Attending 6+
credits
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
C. DEPENDENT STUDENT'S HOUSEHOLD OTHER INFORMATION TO BE VERIFIED
Did someone in the student's household (listed in Section B) receive benefits from the Supplemental Nutrition Assistance
Program/SNAP (formerly known as food stamps) any time during the 2013 or 2014 calendar years?
(check ONLY one)
No
Yes, one of the persons listed in Section B of this worksheet received SNAP benefits in 2013 or 2014. I will
provide documentation from the issuing agency (copy of benefit card is not acceptable).
Did someone in the student's household (listed in Section B), pay child support in 2014?
(check ONLY one)
No
Yes, one of the persons listed in Section B of this worksheet, paid child support in 2014
*1516*
ID #
Self
SUNY Orange
*DVF* 1516 DEPENDENT VERIFICATION FORM (V1 & V5)
If yes, I certify that
one of the persons listed in Section B of this worksheet paid child support in 2014. I have listed below the names of
the persons to whom the child support was paid, the names of the children for whom the child support was paid and the total amount of child
support paid in 2014 for each child. I also attest that I have not included these children as members of my household size. (Parents can either
include these children as members of the household *or* include the amount of child support paid but may not include these children as
members of the household and also list child support paid.
Name who paid the child support
Name who received the support
For whom support was
Yearly amount paid
D. DEPENDENT STUDENT'S TAX INFORMATION TO BE VERIFIED
Did you file / will file a 2014 tax return?
Yes, the student (and, if married, the student's spouse) filed a 2014 federal tax return.
No, the student (and, if married, the student's spouse) DID NOT file a 2014 federal tax return.
IMPORTANT INFORMATION: If you (or your spouse, if married) filed, or will file, an amended 2014 IRS tax return, you must
contact your financial aid administrator before completing this section. The best way to verify income is by using the IRS Data
Retrieval Tool that is part of FAFSA online. If you have not already used the tool, go to FAFSA.gov, log in to your FAFSA
record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there, follow the
instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2014 IRS income tax information into
your FAFSA. It takes up to two weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic
IRS tax return filers, and up to eight weeks for paper IRS tax return filers. If you need more information about when, or how to
use the IRS Data Retrieval Tool see your financial aid administrator.
I, the student (and spouse, if married)
used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my income information into my FAFSA.
have not yet used the IRS Data Retrieval Tool, but I will use the tool to transfer my income information into my FAFSA.
am unable to use the IRS Data Retrieval Tool in FAFSA on the Web -I will submit 2014 IRS tax return transcript(s) to
SUNY Orange.
choose not to use the IRS Data Retrieval Tool in FAFSA on the Web - I will submit 2014 IRS tax return transcript(s) to
SUNY Orange.
was not employed and had no income earned from work in 2014.
was employed in 2014 and will list below the names of all employers and the amount earned from each employer in
2014. I will submit 2014 IRS a letter of “No tax return filed” to SUNY Orange.
*1516*
A#
*DVF*
115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-4194
1 Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
www.sunyorange.edu
1516 DEPENDENT VERIFICATION FORM (V1 & V5)
Complete the section below ONLY if you were employed in 2014 AND DID NOT file a 2014 tax return.
You MUST provide documentation of all monies earned (e.g. copy of W-2).
Employer's Name
Total Amount Earned in 2014
Received a W-2
E. DEPENDENT PARENT'S TAX INFORMATION TO BE VERIFIED
Did the parent (and if married, the parent's spouse) file / will file a 2014 tax return?
Yes, parent (and if married, the parent's spouse) filed a 2014 federal tax return.
No, parent (and if married, the parent's spouse) DID NOT file a 2014 federal tax return.
IMPORTANT INFORMATION: If your parent (and if married, the parent's spouse), or will file, an amended 2014 IRS tax
return, you must contact your financial aid administrator before completing this section. The best way to verify income is by
using the IRS Data Retrieval Tool that is part of FAFSA online. If you have not already used the tool, go to FAFSA.gov, log in
to your FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From
there, follow the instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2014 IRS income tax
information into your FAFSA. It takes up to two weeks for IRS income information to be available for the IRS Data Retrieval Tool
for electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers. If you need more information about
when, or how to use the IRS Data Retrieval Tool see your financial aid administrator.
I, the parent (and if married, the parent's spouse)
used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my income information into my FAFSA.</text>
have not yet used the IRS Data Retrieval Tool, but I will use the tool to transfer my income information into my FAFSA.
am unable to use the IRS Data Retrieval Tool in FAFSA on the Web -I will submit 2014 IRS tax return transcript(s) to
SUNY Orange.
choose not to use the IRS Data Retrieval Tool in FAFSA on the Web - I will submit 2014 IRS tax return transcript(s) to
SUNY Orange.
was not employed and had no income earned from work in 2014.
was employed in 2014 and will list below the names of all employers and the amount earned from each employer in
2014. I will submit 2014 IRS a letter of “No tax return filed” to SUNY Orange.
*1516*
A#
A#
*DVF* 1516 DEPENDENT VERIFICATION FORM (V1 & V5)
Complete the section below ONLY if your parent (and if married, the parent's spouse) were employed in 2014 AND DID NOT
file a 2014 tax return. You MUST provide documentation of all monies earned (e.g. copy of W-2).
Employer's Name
Total Amount Earned in 2014
Received a W-2
Electronic Certification Agreement. By providing your “electronic” student signature, student ID # and by selecting
the “Accept" button, you consent that all of the information reported is complete and correct.
Student: Accept
Student Signature: __________________________________Date:__ __ / __ __ / __ __ __ __
Parent: Accept Parent Signature: __________________________________Date:__ __ / __ __ / __ __ __ __
WARNING: If you purposely give false or misleading information on the worksheet, you may be
fined, be sentenced to jail, or both.
NOTE: A DEPENDENT VERIFICATION WORKSHEET AFFIDAVIT (DAVD)
MUST ALSO BE COMPLETED AND SUBMITTED TO THE FINANCIAL AID
OFFICE.
*1516*
A#
A#
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Completed 20 July 2020

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