Fillable Form 20: 21-2022 DEPENDENT HOUSEHOLD WORKSHEET (V1) (River Parishes Community College)

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Form 20: 21-2022 DEPENDENT HOUSEHOLD WORKSHEET (V1) (River Parishes Community College)

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The Form 20: 21-2022 DEPENDENT HOUSEHOLD WORKSHEET (V1) (River Parishes Community College) form is 3 pages long and contains:

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  • 10 check-boxes
  • 68 other fields

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File type: PDF

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20
21-2022 DEPENDENT HOUSEHOLD WORKSHEET (V1)
Name: ____________________________________ Student ID #: ______________________________________________________
Mailing Address: _____________________________ Telephone Number: _______________________________________________
Email Address:________________________________________________________________________________________________
SECTION 1: HOUSEHOLD MEMBERS
List below the people considered in the student’s household for FAFSA purposes, including:
● Yourself and your parents. If your parents are divorced or separated, then list the parent whom you live
with the majority of the year, or who supports you the most. If that parent has remarried, also include
the stepparent.
● Your siblings, or parents’ other children , if your parent(s) will provide more than half of their support from
July 1, 2021, through June 30, 2022 (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, 2022.
● Include the name of the college for any household member who will be enrolled at least half-time in a degree, diploma, or
certificate program at a postsecondary educational institution any time between July 1, 2021, and June 30, 2022.
● Do not list your parents’ colleges if they are attending college. If more space is needed, attach a separate
page with the student’s name and Social Security Number at the top.
Include all household members, even those who are not in college but meet the criteria listed above.
If more space is needed, provide a separate page with the student’s name at the top.
Full Name Age Relationship to Student
If enrolled in College, list full
Name of College
Enrolled in College at
Least Half Time?
self [ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in
eligible post-secondary educational institutions is inaccurate.
Office of Financial Aid & Scholarships
Gonzales-Westside-Reserve- St. Charles Campuses
Financialaid@rpcc.edu
SECTION 2: STUDENT TAX FILING STATUS
Check the box that applies for the student (Only check one (1) box):
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 2019 IRS Tax
Return Transcript(s).*
The student did not work in 2019 and is not required to file a 2019 tax return with the IRS.
The student did work in 2019, but did not file and was not required to file a 2019 income tax return with the IRS. Please complete the
chart below and attach copies of all W-2’s or 2019 IRS Wage Statement. If more space is needed, attach a separate page
with your name and SSN at the top.
Employer’s Name
2019 Amount Earned
IRS W-2 Attached? Yes or No
SECTION 3: PARENT TAX FILING INFORMATION
Check the box that applies for the parent(s). (Only check one (1) box):
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 2019 IRS Tax
Return Transcript(s).*
The parent (and spouse if applicable) did not work in 2019 and is not required to file a 2019 tax return with the IRS. You must attach a
Non-filing letter.
The student (and spouse if applicable) did work in 2019, but did not file and was not required to file a 2019 income tax return with the
IRS. Please complete the chart below and attach copies of all W-2’s or 2019 IRS Wage Statement. If more space is needed,
attach a separate page with your name and SSN at the top.
Employer’s Name
2019 Amount Earned
IRS W-2 Attached? Yes or No
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
SECTION 4: CERTIFICATION AND SIGNATURES
Each person signing this worksheet certifies that all of the information reported on it and on accompanying documents are complete and correct.
If you purposely provide false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Both the student and parent must sign and date:
__
_______________________________________________ _________________________________
Student’s Signature Date
__
_______________________________________________ _________________________________
Parent’s Signature Date
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Form 20: 21-2022 DEPENDENT HOUSEHOLD WORKSHEET (V1) (River Parishes Community College)

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Completed 3 February 2021

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